Photo Credit: iStock.com/miljko

Yvette C. Terrie, RPh, and Danielle Green, RDN, discuss the obesity epidemic and the many benefits of a holistic approach to safe, sustained weight loss.

The most recent statistics from the CDC indicate that from August 2021 to August 2023, the prevalence of obesity in adults was 40.3%, with no significant variance between men and women.¹  The rates of individuals classified as overweight and obese continue to expand, even among pediatric patients. The NIH indicates that 30.7% of adults are overweight, 42.4% are obese, and 9.2% are severely obese, highlighting the need to continue efforts to identify and address contributing factors and the necessity for patient-centered measures to promote safe, effective, and sustainable weight loss efforts to improve affected patients’ health-related quality of life. ² 

Moreover, effectively addressing weight issues has the potential to diminish or prevent the development of common chronic comorbidities, including but not limited to cardiovascular disease, diabetes, hypertension, stroke, myocardial infarction, metabolic syndrome, certain cancers, and osteoarthritis. In addition, individuals may struggle with weight issues because of having certain medical conditions, for example, hypothyroidism and polycystic ovarian syndrome. ^3,4  Some patients may also struggle with weight issues in varying degrees due to the use of some pharmacological classes of drugs, for example, beta (β)-receptor antagonists, corticosteroids, and neuropsychotropic medications, including atypical antipsychotics, antidepressants, and antiepileptic drugs. ^3,4

Weight Loss Research

An abundance of research has established that successful and sustained weight loss warrants lifestyle changes such as consistently maintaining a healthy, balanced diet, implementing a tailored exercise regimen, and managing stress. Some patients may also benefit from the use of weight-loss prescription medications.

According to the Obesity Medication Association, clinicians typically consider prescribing weight loss medications in a patient with a body mass index (BMI) of 30 kg/m² or greater or a BMI of 27 kg/m² or greater if the patient has weight-related medical conditions.⁵  A recent study published in JAMA Health Forum indicated that due to growing popularity for weight loss drugs, prescriptions for semaglutide expanded by more than 400% between January 2021 and December 2023. The authors wrote, “ Increased awareness of semaglutide’s weight loss benefits has fueled demand, including for off-label use.” ⁶

A study published in JAMA Network Open discovered that the vast majority of patients taking semaglutide halted the drug within two years, resulting in a regression in weight loss, and some patients are not aware that the effectiveness of this drug requires continued use. The authors wrote, “Weight loss, income, and adverse events were significantly associated with discontinuation, while weight regain was significantly associated with reinitiation.” ⁷

Numerous studies have also shown that semaglutide is safe and effective when combined with lifestyle changes, including diet and exercise; however, some clinicians have expressed concerns that weight loss drugs are sometimes overprescribed, especially in patients who only need to lose a few pounds, and that a holistic approach to weight loss is more beneficial for most patients.

An Expert Weighs In

Danielle Green, RDN, an integrative and functional nutrition certified practitioner, licensed nutritionist, licensed registered dietitian, and certified personal trainer, shared her expertise, insights, and recommendations regarding the benefits of the holistic approach to safe, effective, and sustained weight loss:

Yvette C. Terrie, RPh: What do you believe are the factors contributing to the ongoing obesity epidemic?

Green: Some originally well-intentioned factors contributing to this issue include easy access to food (fast food restaurants, meal delivery services, etc.) and a lack of encouragement for daily movement. In addition, many people work long hours and may have long commutes to and from work, resulting in less time for quality meals and leaving them too exhausted to engage in basic daily movement or physical activity.

What are your thoughts on the growing use of GLP-1 RAs to promote weight loss?

GLP-1 RA medications should never be the first intervention for addressing weight loss. Furthermore, in most cases, individuals should not consider this option if they have never attempted to change their lifestyle for at least two years. On the flip side, if one were to take the aforementioned medications (after two years of lifestyle changes using one plan instead of yo-yo dieting) for weight loss, they would need to be closely monitored by a dietitian and their primary care physician.

Should clinicians rely on factors other than BMI when assessing whether patients need to lose weight?

All clinicians must consider a few factors when assessing whether patients need to lose weight. Some include: using a DEXA scan or an InBody-like scanner to assess skeletal muscle mass versus fat mass; determining if the individual participates in a sport that requires them to carry a bit more “weight,” such as a football player or bodybuilder or whether that individual is currently experiencing a stressful/challenging period in life (such as losing a loved one, loss of employment, or receiving a serious health diagnosis for themselves or a family member).

What are your recommendations for long-term weight management? What do patients typically struggle with?

The overachieving concept I discuss for long-term weight loss management is the 80/20 rule (which emphasizes that flexibility is key). Within this framework, I review several factors with my clients: daily walking (step count), hydration, overall food quality, sleeping habits, and exercise routines (strength training and cardio). Typically, patients struggle with being too extreme for 2-3 weeks by attempting to change all the factors listed above without any “days off, ” leading to burnout and frustration.

Any additional advice for individuals seeking to lose or sustain weight?

Find non-scale goals, situations, or events that will keep you motivated when (not if) the journey gets hard. Ultimately, know your “Why” and be okay with seeking accountability; we all need it in one way or another.

The Need for Healthy Habits

Collaborative efforts among healthcare providers in various areas of clinical practice can be instrumental in identifying ideal candidates for weight loss and providing patients with practical, patient-centered care approaches to promote sustainable weight loss, thereby improving overall health and quality of life. Patients should be encouraged to actively participate in their weight loss journey, set realistic expectations to avoid discouragement, and understand that their goals can generally be achieved with dedicated efforts. The first important step in the right direction is implementing healthy habits such as balanced diets, portion control, and tailored exercise plans based on overall health status.