Traditional strategies for weight loss:

• Exercise is very important — 20 – 30 minutes of vigorous exercise, at least 3 days per week, but preferably 5 days per week, is ideal.
• Read food labels carefully. It is important to keep track of your daily calorie intake. At the top of food labels, there will be “Total calories” and “Total calories from fat”; the total calories from fat should be 1/3 of the total or less (preferably much less).
• At least 2 days per week, keep a very accurate log of food intake and estimated calories. This feedback has been proven to help with weight loss.
• Consider the South Beach Diet — this is a low-carb diet (like Atkins), but without all the meat and cholesterol. It’s emphasis is on fish, fruits, vegetables and olive oil.
• The usual goal is 1 – 2 pounds of weight loss per week. Remember, 1 pound of fat is 4000 calories, so to lose 1 pound per week means taking in about 550 calories per day less.

Pharmacological Aids:

Older medications

Phentermine has been around for decades; Orlistat (aka Xenical or Alli) was introduced in 1999. They have their uses but, frankly, have a poor ratio of side effects vs benefits.

Newer drugs include Contrave, Qsymia and Imcivree. These are a bit more effective, but have never really taken off as popular weight-loss medications.

The newest weight-loss aids are the GLP-1 agonists (semaglutide and liraglutide) and the combination GLP-1/GIP agonist tirzepatide. These are a major leap forward, with excellent weight-loss potential and, in most cases, tolerable side-effects.

These drugs were originally designed as medications for diabetes, but it was soon discovered that they were very good for weight loss. They work by, essentially, slowing down the gastrointestinal tract — food moves moves through the digestive tract more slowly, so you feel full longer and don’t feel hungry.

Not all of the drugs in this class have been FDA-approved for weight-loss; there are currently three:

Semaglutide: a GLP-1 agonist originally approved for diabetes as Ozempic and Rybelsus; the version approved for weight-loss goes by the brand name Wegovy.

Liraglutide: a GLP-1 agonist approved for diabetes as Victoza; the weight-loss version is Saxenda.

Tirzepatide: a GLP-1/GIP agonist approved for diabetes as Mounjaro; the weight-loss version is Zepbound.

All are good for weight loss; studies show Zepbound to be a little better than Ozempic, which is better than Saxenda.

Side effects need to be considered. Nausea is fairly common in the beginning. It can be a major issue for some patients. Pancreatitis, an inflammation of the digestive organ that sits behind the stomach, can occur. It’s not a common problem, and is rarely life-threatening when caused by these drugs, but is a potential complication that needs to be factored in. Thyroid tumors can, rarely, occur. Because of this, anyone with a genetic condition called MEN-2 (Multiple Endocrine Neoplasia, Type 2) cannot be prescribed these medications.

Despite being the most effective of the three drugs, Zepbound’s side effects seem to be slightly milder than the others.