Finally a Real Solution for Weight Loss from the Pharmaceutical Industry

Weight Loss is Easier to Achieve with Prescription Peptides

A Closer Look at the Body Mass Index Scales

Obesity has become an epidemic in the US and continues to be the #1 health crisis affecting this country. According to data from 2020 for the Centers for Disease Control and Prevention, 74% of Americans are considered overweight (Body Mass Index/BMI >25) and 43% are considered obese (Body Mass Index/BMI>30). I could get into a long diatribe about the imperfections of the body mass index as a measuring tool as I would be considered overweight (height of 71 inches and a weight of 195 with BMI of 27.2) even though my body fat percentage was last checked on DEXA scan was 12.1%. Even with the limitations of this measuring tool, the numbers are troubling.

Obesity increases the risk for the following issues and negative health consequences including, hypertension, dyslipidemia, type II diabetes mellitus, coronary artery disease, stroke, gallbladder disease, non-alcoholic fatty liver disease, chronic inflammation, sleep apnea, cancer, mental health disorders, hormone disorders, and physical functioning limitations. The positive side of this discussion is that these issues are easily fixed via lifestyle modifications, supplementation, bio-identical hormone optimization, exercise, weight loss peptide therapies, and medications. 

The old school thinking for weight gain has centered upon too much intake and too little exercise. The “calories in, calories out” mantra has been beaten into our heads by the media and the medical establishment even though the discussion is more nuanced than just a simple calculation. All calories are not the same and the intake choices make a significant difference in body composition. For example, a bag of Doritos and a piece of steak may have similar caloric values, but the effect on the body would be totally different due to the nutrient density of the food with the latter being better than the former.

Hormones including cortisol, insulin, leptin, ghrelin, thyroid, growth hormone, testosterone, estrogen, progesterone, DHEA, and many others also play a significant role in weight gain and weight loss. Weight gain and body fat deposition are therefore multifactorial and require a multifaceted evaluation of the contributing factors. Thus, the comprehensive approach to the management of weight and obesity issues is essential to the resolution of this health challenge. This workup includes an in-depth history and physical exam, blood work, genetic evaluation, wearable data information, and a DEXA/body composition scan.

The treatment of weight gain and obesity issues primarily focuses on reducing chronic inflammation and resolving insulin resistance. This involves optimization of the foundational principles of health including sleep, stress reduction, sun exposure, nutrition, meditation, exercise, life purpose, detoxification, sauna, and cold exposure.

Blood work assessment and clinical evaluation will provide the information to optimize hormones for both men and women including testosterone, thyroid, estradiol, insulin, DHEA, growth hormone, and cortisol. Micronutrient and mitochondrial health support optimization including magnesium, CoQ10, B Vitamins, NAD+, Vitamins A, D, E, and K, and amino acids. Optimal macronutrient intake of protein, carbohydrates, and fats along with the timing of the intake more in a time-restricted eating pattern or intermittent fasting patterns are essential for body composition transformation. Sprinkling in a weekly 24 hour fast and a quarterly three-day focusing on autophagy-fasting, enhancing AMPK activation (catabolism), and reducing mTOR (anabolism). 

The blood evaluation also allows us to assess and monitor the inflammatory markers including C reactive protein, homocysteine, ferritin, fibrinogen, fasting insulin, interleukin 6, tumor necrosis factor-alpha, low albumin, high globulin, and elevated cortisol levels. Fasting glucose levels, fasting insulin, hemoglobin A1C (glycosylated red blood cells), and fructosamine (glycosylated protein) are also blood markers to assess both the short and long-term levels of glucose control. A continuous glucose monitor such as a Freestyle Libre or a DexCom would also be employed to monitor the response of blood sugar to specific foods, fasting, and exercise. All of these data points are helpful in establishing a baseline and formulating a plan for treatment. These markers may then be followed to assess for improvement and resolution. 

Supplements and medications have a role in reducing chronic inflammation, regulating blood sugar and insulin levels, and enhancing weight loss. The first would be berberine or dihydroberberine which is a plant-based compound available over the counter as a supplement. This is typically taken two to three times per day with meals and has the effect of stabilizing glucose and insulin levels, reducing lipids (LDL and Triglycerides), and improving blood pressure. The second would be a prescription medicine called Metformin. Next to creatine, this is the most studied substance in the medical literature. Metformin is typically taken two times per day with meals and has the effect of reducing glucose release from the liver, increasing insulin sensitivity, increasing AMPK and autophagy, enhancing the gut microbiome, and reducing the risk of colon cancer and dementia.

Is Peptide Therapy Effective For Weight Loss?

Weight loss peptides such as Tesamorelin, Sermorelin, MK677, MOTS-c, Tesofensine, Amlexanox, Tetradecylthioacetic acid (TTA), 5-Amino-1MQ all may have a role in weight loss and body composition. These options may be included in a comprehensive program and/or in combination with the newest addition to the armamentarium for physicians, a drug/peptide called Semaglutide.

Semaglutide is a GLP-1 (Glucagon like peptide-1) agonist which works to help with weight loss solutions via multiple mechanisms. 

The first is that it stimulates insulin secretion from the pancreas (but lessens insulin spikes) to help reduce blood glucose which ultimately reduces cortisol levels and chronic inflammation. It also inhibits glucagon secretion via a negative feedback loop which serves to reduce the breakdown of glycogen from both the liver and muscle. This also serves to reduce serum blood glucose. Second, the medication reduces hunger and cravings via direct stimulation of the hypothalamus and hindbrain as well as the vagus nerve, This stimulation serves to curtail food intake by 35% which further enhances weight loss. 

In a 2021 study published in the New England Journal of Medicine, a weekly injection of 2.4 mg of Semaglutide was compared to a placebo in patients that had a BMI>30 and no evidence of diabetes. Both groups were instructed on lifestyle modifications. After 68 weeks, the Semaglutide group lost on average 15.3 kg (33.7 lbs.) which correlated to about a 15% change in body weight. The placebo group in contrast lost on average 2.6 kg (5.7 lbs.) which correlated to about a 2.4% change in body weight. 

The Semaglutide group also showed improvement in cardio metabolic risk factors as well as physical functioning. The main side effects were nausea and vomiting which were typically transient, but 4.5% of the treatment group stopped the drug due to these issues. 

Semaglutide has been shown to have multiple positive effects on the body as a whole. Negative health consequences of common cardiovascular abnormalities including hypertension, triglycerides, lipids, inflammation, diabetes mellitus II, and sleep apnea typically improve and/or resolve while on treatment. The medication also slows gastric emptying which serves to limit insulin elevation and enhance satiety. It also serves to change the gut microbiome for the positive in combination with butyrate and probiotics. It has a positive effect on bile acids which helps to reduce cholesterol and fatty liver. 

Semaglutide has a role in brain optimization by directly affecting astrocytes in the brain in a positive manner. Optimal astrocyte function enhances physical and metabolic support for neurons, detoxification, support of the blood-brain barrier, and repair during injury. It works via reducing inflammation in the brain, halting and reversing the effects of Alzheimer’s disease, and reducing beta-amyloid plaque. It would also serve as an alternative in treating the endocrinologic abnormalities associated with polycystic ovarian syndrome. 

In conclusion, weight loss and body composition improvements require a comprehensive approach to transformation with the understanding that this is more of a marathon than a sprint. There is no 30, 60, or 90 days fix to the problem. The foundational pieces and bio-identical hormone optimization are the mainstays of treatment. There is however a myriad of options available highlighted in this blog to further enhance transformation and vitality. 

The medication Semaglutide (Wegovy) was approved for weight loss in June of 2021 and was the first drug approved since 2014. The beauty of this medication, in comparison to others like phentermine/topiramate (Qsymia) and naltrexone/bupropion (Contrave), is that it has the ability to cure the problem of obesity including the sequela as it gets to the root cause of the problem as opposed to treating the symptoms. This is counter to the typical drug formulated by the pharmaceutical industry which treats the symptoms, solves very little thus requiring chronic need, and requires alternative medication intervention for side effects or other issues. 

Semaglutide solves the obesity and inflammation issues and reduces the need for antihypertensives, lipid-lowering agents, and alternative blood sugar control agents. 

Joi Women’s Wellness physician-directed programs using a precision medicine approach provide you with the best opportunity for success and with the help of concierge coaching. Please reach out and schedule a consultation to transform your health and focus on longevity and vitality for the New Year.  

1. Once-Weekly Semaglutide in Adults with Overweight or Obesity. Wilding et al. March 18, 2021, N Engl J Med 2021; 384:989-1002 

2. Metformin in 2019. James Flory, MD, MSCE; Kasia Lipska, MD, MHS. April 22, 2019. JAMA. 2019;321(19):1926-1927. doi:10.1001/jama.2019.3805

Michael J. Meighen, MD 

The Live Limitless MD