Jane and Laura, former work colleagues, haven't seen each other in over a year and they both attend a party hosted by a mutual friend. Jane is shocked to see Laura looking well: Svelte and rocking a flattering, one-piece jumpsuit. As she observes Laura, with newfound confidence, casually conversing with other guests and sipping sparkling water, Jane rolls her eyes and thinks to herself, "I bet she's taking those 'skinny shots'." Laura, meanwhile, has been asked repeatedly over the last year what she's doing to lose weight: If she's hungry all the time, if she's starving herself, if she's living on lettuce and water, if she's using medication, and a host of other probing questions that loop through her brain every time she walks past a mirror, shops for groceries, or tries on an outfit that she hasn't been able to comfortably wear for years -- second-guessing her decision to request medical weight loss support.
Nick has always been the "big guy" in his office, surrounded by golfers and runners who seem to have never struggled with their weight. Nick's life has consisted of a series of major stressors that have hijacked his nervous system, taxed his adrenals, disrupted his gut barrier, and led to a gain of 50 lbs that his body has retained for at least a decade. He's tried CrossFit, intermittent fasting, keto dieting, so-called "fat burner" supplements, and meal-replacement shakes but every time his weight decreased by a few pounds, he regained the weight and then some within a short time. The office manager where Nick works spends a sizeable portion of her monthly budget to provide donuts, cinnamon buns, pizza, muffins, and a range of other unhealthy edible items for the group. Due to chronic stress and related inflammation, Nick's gut doesn't absorb nutrients very efficiently and he's continually hungry as a result. Nick wants to improve his health but at the consult to discuss medication to help with weight management, he tells his healthcare provider that he's "on the fence" about losing weight because he's concerned that his colleagues will notice and he doesn't want them to find out that he "cheated" by taking medication.
I see scenarios JUST like these in my practice every week. My clients want to feel and look healthier, to have more energy, to sleep better, to manage chronic pain, and to get off the treadmill of conflicting advice that has gotten them nowhere -- but they're too often fearful of being judged. They hear the gossip whispered behind the backs of friends and family who have pursued medical weight management and understand that using medication to help with weight loss is still stigmatized. They're afraid of being seen as lacking discipline or willpower. The truth is that people who struggle with weight are some of the strongest, most resilient individuals who have often survived and overcome intensely-stressful circumstances and life events. They've put forth the effort and followed the advice of professionals. The problem ISN'T discipline or willpower at all. Their bodies are in a protective, survival mode. Pushing harder makes things worse, not better. Stress hormones are out of control. The gut barrier is disrupted and leaky, triggering the immune system's inflammatory responses. Fat is metabolically-active, living tissue that impacts hormones and therefore contributes to the dysregulation of mood, appetite, sleep, energy, and other aspects of well-being. The metabolic activity of fatty tissue actually creates a self-perpetuating cycle in which the presence of fat stimulates the growth and storage of more fat. Once this cycle is established, carrying unhealthy weight is a medical condition that often responds best to medical intervention. Pushing the body harder with less sleep or more exercise, and/or reducing caloric intake increase the stress burden on the body, elevating cortisol, which leads to the conversion of additional lean body mass to fat.
"How do medical interventions help resolve these problems? Don't medications just mask problems?" you may ask. In my practice, I take the time to hear my clients' stories and to understand how and why they reached this place on life's journey. I share recommendations and information rooted in the research literature, and together, the client and I develop a plan that supports healthy changes. Medication can help dial down cravings, address underlying inflammation, and promote satiety while the client makes healthy changes. Medication and lifestyle changes work together. When the client has reached his/her desired weight and is comfortable with the new, healthier habits, we can start to decrease the medication dose, discontinuing it completely for many. Medication isn't a "quick fix" or "magic shot (or pill)" -- It's a tool to be prescribed judiciously to individuals for whom the benefits outweigh the risks. Using weight loss medication isn't "cheating" or "lazy" --The client must commit to addressing the underlying causes of the weight gain and commit to developing healthier habits in order to achieve lasting success.
It's beyond time to stop stigmatizing medical weight loss treatments and to celebrate that so many of our friends, family, and neighbors in the community are taking the step of getting the help they need to live healthier, more active lives, feeling confident and self-assured in their bodies -- many for the first time. If you or someone you know in Montana is struggling with extra pounds and unsure of where or how to begin, I can be reached at (406) 219-7874 or via the booking page on this website.
