We're biologically programmed to gain weight and our bodies are excellent at using as little stored energy as possible. We are not designed to live at a weight that keeps our health risk at an ideal level. This is a world where you can take in 2,000 Calories in a sitting and not be full (cue video of me eating a whole large pizza on my own, which has happened and may happen again).
The secret to weight loss is there is no secret. It's hard and you probably don't need me to tell you that. It is more likely to be successful long term with help, but medication and medical guidance are not absolutely necessary or guarantees of weight loss. You can lose weight on your own, you can keep it off on your own, but fighting against biology is an uphill battle. Medication and guidance can help even the odds and make it easier to do.
The math is straight forward: use more Calories than you take in (we call it a Calorie deficit). 1. Increase how many Calories you use. 2. Decrease the amount you take in. Best results are achieved with both.
1. Increase Calorie use by adding activity that is distinctly separate from your routine. This doesn't have to be suddenly becoming a gym pro. For me, this was adding 10-15 minutes three to four times a week for any activity that got me out of breath. Treadmill fast enough that I can't talk to my many cats. Go up and down stairs while I listen to a podcast. Recumbent bike or elliptical while I watch an episode of anime or stream a show, bonus if it's exactly 20-30 minutes. Unfortunately, we are very efficient beings and the Calorie impact of this can be reversed by 3 minutes of quality time with a candy bar. Example: I jog 2 miles in 24 minutes, I expend 290 calories. Regular sized Snickers bar is 250 Calories. This doesn't negate the impact of extra activity, but emphasizes the need for other ways to help amount to a Calorie deficit. Still, imagine 4x/week, 290 Calories, 4 weeks/month = 4,640 Calories. You need a deficit of 3,500 Calories to burn 1 lb of store fat. If you were previously maintaining your weight and continue to eat the same, you will be 12 lbs less by next year and keep it off just with an extra 20-30 minutes four times a week. It adds up. Losing weight slowly and surely gives your body time to adjust.
2. Decrease the amount of Calories you take in. There are many ways of doing this, none of which can necessarily be called better than any other. Restricting food types, counting Calories, assigning points, or intermittent fasting. The problem with dieting like this is most of these diets promote a lifestyle that is unpleasant to maintain. Once weight is lost, most people will want to ditch the restrictive diet. I tried life without carbs and had some very uncomfortable dreams about bread and cake. A good way to go about this is to find the food lifestyle that fits the weight you are aiming for and still allows you to enjoy your food. The way I do this is promoting fullness by selecting low Calorie high bulk foods, timing them to keep me full, and planning for cravings.
Example: I eat a 100 Calorie cheese stick about 30 minutes before I eat my meal because my body will start to digest it and give me a partial feeling of fullness before I've even considered seconds. I fill my plate with a low Calorie vegetable or bulk type food like mushrooms (110 Calories per POUND! :0), broccoli, seasoned roasted carrots, or cauliflower. Amazing savory, salty, or sweet recipes exist for all of these that are low Calorie (see our recipes!) I can then be mostly full by the time I get to more Calorie dense items like carbohydrates (rice, pasta which I limit to the size of my palm for 150-200 Calories) or even my protein depending on the cut. Chicken breast 130 Calories per 4 oz, lean cuts of steak like Sirloin (200-250 Calories/4 oz), or shrimp 80-90 Calories per 4 oz. Protein takes longer to digest and delays your stomach from emptying while it uses acid to break it down. This is why protein rich diets cause you to feel more full while taking in less Calories. Carbohydrates are rapidly absorbed and can pack enormous amounts of Calories into small servings. It's no wonder keto and Atkins can be initially effective, but tend to fail as people realize how difficult it is to sustain long term.
2b. Where we come in. The newest and most effective weight loss medications cause weight loss by making you feel more full most of the time. These are known as GLP-1s (glucagon like peptide-1 agonists). They affect a lot of parts of the body, but most relevant to our purposes, they delay gastric emptying, meaning they keep the food you eat in your stomach longer which sends signals to the brain that you are full with less food and stay that way for an extended period of time. Imagine feeling like you got your money's worth at a Brazilian steakhouse, but in reality only ate a 300-400 Calorie portion of whatever you wanted. You just felt full, satisfied, and will remain that way without having to sacrifice types of foods you like. Other medications like topiramate and bupropion can do similar things for a fraction of the cost, but not are not as potent.
Recommended links:
These sources of information are highly trustworthy. They are published by the same smarty-pants scientists [read: brilliant experts] you would run to if you had a mystery illness or if the bubonic plague sprang back up. All of the advice they give is backed by rigorous experimentation that ensure it is valid and relevant.
Short Version:
-Weight loss is hard because bodies are designed to keep weight and reward you for eating Calorie rich foods.
-Lose weight by reducing Calorie intake and increasing Calorie usage. Exercise burns only small amounts of Calories. Restrictive and fad diets often do promote weight loss, but are hard to keep up so you regain weight after inevitably stopping. Medications can help do both, though most help promote feeling full to reduce Calorie intake.
-Best strategy recommended:
1.Minimally restrictive Calorie reduction and monitoring. Count Calories on app like myfitnesspal, but restrict only enough to lose small amounts of weight over long period of time 1/2lb to 1lb per week, around 1200-1800 Calories/day allowance depending on starting weight and height.
2. Exercise sustainably and simply minimum 3-4x/week 15-30 minutes anything that gets you out of breath (e.g. Monday, Wednesday, Friday; I take a brisk walk on a 2 mile path around my house while I listen to podcasts)
3. Add medications to cut cravings and promote fullness. $200-400/month semaglutide most effective, sometimes but rarely covered by insurance. $5-50/month bupropion or topiramate, less effective but substantially more accessible, often covered by insurance, cash prices as low as $5/month, also significantly promote fullness. Phentermine/topiramate stimulant type medication still $170/month, cardiac side effects possible. Bupropion, cheap, possibly less effective, psychiatric medication for depression.
Weight loss reflects results at 52 weeks, except for semaglutide and liraglutide, which reflect weight loss at 68 weeks.
FDA: US Food and Drug Administration.
Courtesy of George A Bray, MD. Data from:
Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: A systematic review and meta-analysis. JAMA 2016; 315:2424.
Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: The STEP 8 randomized clinical trial. JAMA 2022; 327:138.
Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021; 384:989.
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