WEIGHT LOSS

 Conversations regarding weight loss are prevalent in the OBGYN consulting rooms. We encounter many females with obesity who have irregular menstruation and fertility struggles, and they are desperately looking for a quick fix to regulate their hormones. They do not want to hear the advice regarding healthy eating and regular exercise. I recently consulted a girl who managed to regulate her menses by losing 20 kg and came for her viability ultrasound and she was 8 weeks pregnant. She was still obese and we consider this a high-risk pregnancy, but without weight loss, we do not see the desired results. I have also met several patients who were turned away from fertility clinics to do weight loss surgery and then start fertility treatment.

Another category of patients is women in the postpartum period who are trying to lose pregnancy weight. This period has it is own unique challenges. A busy and sleep-deprived mother can hardly find the time and energy to exercise. A lot of women spend the first 6 weeks to four months postpartum period at home and they might turn to high-calorie foods and unhealthy lifestyles. I personally believe that after the COVID-19 pandemic, a lot of women stopped their gym subscriptions and outdoor activities and now prefer to stay at home and order takeaway food. Having support in the postpartum period is important for women to be able to look after themselves and shed pregnancy weight.

The menopausal period is another era where women start feeling uncomfortable with their weight. I had a patient who was in her late forties. She was a flight attendant and they needed to stay in shape for their job. And she started noticing increased central obesity and she was struggling to fit into her work clothes. We had to prescribe some anti-obesity medication for her because she needed results within a short period.

We know that there are several useful anti-obesity medications in the market, however healthy nutrition, physical activity, and behavioral modification remain key pillars of weight management. Women in whom anti-obesity medications may be indicated are those with a BMI of 30 or greater, those with a BMI of at least 27 along with at least one obesity-related comorbidity, such as hypertension, high cholesterol, diabetes, or sleep apnea. The goal of treating obesity with medications is at least a 5%-10% reduction in body weight.

There are three basic categories of anti-obesity medications. The short-term options include phentermine and diethylpropion. Long-term options are Orlistat, phentermine/topiramate ER, naltrexone/bupropion ER and lastly, we have the three GLP-1 receptor agonist drugs, liraglutide, semaglutide, and tirzepatide. The GLP-1 agonists have shown very promising results in clinical trials with most patients losing up to 20% of their body weight. I will dedicate a blog to elaborate on the dosage, regimens, and route of administration of the GLP-1 agonist agents.

 




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