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What to do when you feel like your Obesity medication is no longer working! Part 2

What to do when you feel like your Obesity medication is no longer working! Part 2

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You have been on Saxenda, Ozempic or Trulicity for a few months now. At first, everything seemed great; your appetite and cravings for food were reduced, and hey, you lost a bunch of weight! Amazing! For many of you, these medications seem like a God-send. Finally, something that works, something that makes it easy and possible to lose weight the weight you have been fighting your entire life. 

However, now the medication seems to be no longer working. Your hunger and appetite are returning, and the 1 or 2 bites of food that previously made you full are no longer sufficient. Now, you are eating your entire plate of food and feeling that pull back to the chip and candy aisle. Your fear and anxiety start to rise as you become more concerned with gaining the weight back, AGAIN. ‘Is this going to be another failed attempt at weight loss?! It was so easy. WHY does nothing work?! WHY can’t I keep my appetite under control?!’ This is a typical story I hear far too often in my practice. 

If you haven’t checked out Part 1 in this series, go and do that now! I review in detail WHY it seems like your weight-loss medication is no longer working. As a brief refresher – your medication has not stopped working, BUT the side effects from the medication are subsiding. 

 

GLP-1 recap

GLP-1 drugs slow down how quickly food moves through your GI tract. This leads to food sitting in your stomach for longer periods, and with it can come nausea, stomach upset and constipation. This, for a majority of people, makes it very difficult to eat; thus, you lose weight. However, this is a side effect. As your body gets used to the medication, the speed at which food moves through your GI tract returns to normal. Many people believe this is how these medications work in helping you lose weight, as you can feel your appetite diminishing. However, these medications exert their weight management effects via the brain and not the stomach. They act in the reward centres of your brain, reducing your food-seeking behaviours and appetite.

 

Great, now what?!!?

Now I am sure you are saying, ‘Well, that all sounds wonderful, Dr. Dan, then why the hell am I craving chocolate again like basic white girls crave everything pumpkin spice in the fall?!’ 

I am so glad you asked. You see, we need to realize that these medications are a tool to be used in conjunction with lifestyle modifications and changes. They help to lower the barrier in choosing the apple over the apple pie more consistently. Part of a healthy lifestyle and/or weight management protocol is ensuring we eat adequate calories and nutrients, such as protein. If we don’t, and we are losing weight, as I explained in Part 1 of my series on the primal brain, your brain is going to start flipping tables, like white girls when Starbucks runs out of pumpkin spice lattes. Upregulating your appetite hormones and downregulating your satiety hormones make you SEEK FOOD OUT AND EAT! 

So how do we keep your brain and the basic white girls relaxed? 

We give them what they want – food and pumpkin spice lattes. Now anytime you aim to lose weight or go into a caloric deficit, your body will adjust your appetite and satiety hormones. The more extreme the calorie deficit and the greater the weight loss, the more your hormones will be out of balance. The worse they are, the harder they are to manage regardless of how much exogenous satiety hormones such as Saxenda or Ozempic you might be injecting. Our goal is to find a balance, to create a calorie deficit that can lead to weight loss and not throw off your appetite hormones so much that you cannot successfully manage your appetite with the support of medications. 

 

So many calories should I be eating? 

For a vast majority of people, that means eating a reasonable amount of calories and protein. And no, 1200 calories/day is not adequate; that is the amount needed to sustain a small toddler or very petite female. I am assuming ~30% of you are psyched, and the other 70% are now squinting at their screen trying to decide if they should continue to read on or give me the middle finger; to the latter group, may I offer the option of doing both while I explain? 

There are 2 possible reasons for your furrowed eyebrows:  

  1. Eating more calories sounds utterly counterintuitive to everything you are trying to do and have done for the entirety of your life in attempting to manage your weight.  
  2. You have a misconception that eating 1200 calories or less per day is the ONLY way to lose weight. 

Let me share with you a couple of simple calculations to determine approximately how many calories and how much protein you should be aiming to eat each day to lose and manage your weight. 

  • Calorie Intake = Goal Body Weight (lbs) x 12 
  • Protein Intake = Goal Body Weight (lbs) x 1

Goal Body Weight is also known as Lean Body Mass; however, what the hell that actually means isn’t as straightforward. For simplicity, your Goal Body Weight is the weight you would like to reach or the weight you would be at your leanest. 

Let’s do an example. Individual A is currently 300lbs, and their Goal Body Weight is 200lbs: 

  • Calorie Intake = 200lbs x 12 = 2400 calories/day 
  • Protein Intake = 200lbs x 1 = 200g protein/day 

Ok, at this point, I know for a fact that you are giving me the middle finger and mouthing the words, ‘VA-CUUM’ at your screen. ‘How in the actual eff can I eat that many calories and that much protein?!’ I assure you I have heard this 100s of times. Don’t get me wrong; this does not take away from the complexities of obesity and human physiology. For a small portion of individuals, these calculations may not suffice. You will need more specific recommendations for your specific health outcomes, which I hope you are currently working with a care team. However, for a vast majority, like 98% of individuals struggling to manage their weight, these calculations can be a helpful starting place leading to weight loss if you are consistent! 

 

I don’t believe you. But go on… 

‘How in the va-cuum could this possibly work?!’ 

Eating 1200 or fewer calories per day can work – you can lose weight following a diet with this low of calories. Unfortunately, IG influencers and clinicians alike still recommend calorie intake this low. However, it will never be sustainable long term because one, it is very challenging to ensure you are obtaining an adequate amount of nutrition. And two, your basic white girl brain gets cranky without her pumpkin spice latte and ultimately slows down your metabolism. 

Obviously, a lot more science goes into this, and I will review it in future blogs and a free webinar on September 22, 2021, at 6 PM MST *wink wink* if you haven’t signed up yet! 

Believe it or not, we can mitigate the above with more calories while losing weight! I know it’s counterintuitive and even downright terrifying to think about increasing your caloric intake and risk potentially gaining weight. Initially, there might be a small weight gain like fractions of a pound, which will likely be water weight more than anything, but I am asking you to consider giving it the good ol’ college try – at least for a month consistently and see how it goes! I mean, what do you have to lose? 

 

So if I eat more calories, I’ll lose weight?  

I don’t expect you to go from 0 to 100 overnight in terms of a higher calorie and protein intake. Take it SLOW. Start with 1 meal and add an extra serving of protein – vegan and animal-based proteins are equally effective. For reference, 1 serving of protein is the size of a deck of cards or the palm of your hand. For those of you that like numbers, it is ~20-30g of protein which is about 1 chicken breast; this additional serving would only be ~100-150 extra calories per day. Do that for 1 week and see how it feels. Then, add another portion of protein to another meal or snack and so on! 

Obtaining 200g of protein in a day is much easier than one realizes; you just need to focus on protein intake. Keep it simple and take it slow. And do not worry if you have healthy functioning kidneys; there is no concern with harm – even for our 200lbs individual, a diet composed of ~250g of daily protein has been shown to be safe and possibly improve weight-loss outcomes. 

You might not ever actually reach your calculated calorie and protein intake, and that is OK. Work towards these goals consistently for the best results, and remember these are just targets to aim for. Fundamentally, aiming for them will help to improve your overall health, which is most important!

 

Final thoughts

As a final point, I am sure many of you have one more question: ‘when should I start incorporating this after starting one of these medications!?’ I generally recommend optimizing your diet before initiating the medication and then continuing to optimize while you are on the medication. Now the side effects may make this challenging, and you might not be able to increase your food intake until the side effects start to wear off, and that is OK. So again, take it slow and build up over time! 

Alright, this might be my longest and most vacuum-worthy blog yet! Again, I know it seems counterintuitive and goes against everything you have learned over the years, but the science is changing. I have successfully helped many individuals by doing precisely what I described above and have supported them in finding that balance and ensuring their medication continues to be effective! I know this was a lot so please feel free to drop your comments and questions below. I will do my best to answer them or make subsequent follow-up videos! 

Until next time my friends! Always remember that small tweaks lead to massive peaks! 

-Dr. Dan

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