You’ve tried to do everything right. You’ve passed on the Buffalo chicken wings on poker night. You’ve cut back on alcohol and switched to light beer. You’ve even joined the local gym. Nothing seems to work—those extra 50 lbs. won’t budge.
Well, you’re not alone.
Obesity is a chronic disease where the pathways that control how much we eat can lead us to take in too many calories and accumulate excess fat that promotes health complications, says Dr. Jose O. Aleman, an endocrinologist at the VA New York Harbor Healthcare System, Manhattan Campus. When coupled with easy access to poorly nutritious food, individuals with obesity often struggle with their weight loss goals.
“I tell my Veteran patients that even though 10 pounds doesn’t sound like a large amount of weight, it is the type of weight loss that tends to be sustainable,” Aleman said.
Physician supports use of weight-loss medication
Aleman is the director of the NY-MOVE! Endocrinology Weight Management Clinic at the NY-Harbor VA. He also leads clinical research to find the best ways to help Veterans reach a healthier weight.
Aleman and his team published a study in the journal Obesity that examined the effectiveness of pharmacotherapy – weight-loss medication – when combined with lifestyle changes. The study confirmed the benefits of medication but noted significant variability among individual patients. The researchers found the most effective weight-loss agents were phentermine/topiramate (Qsymia), followed by liraglutide (Saxenda) and orlistat (Alli).
“Both at the local and national level, we found obesity pharmacotherapy is effective in changing the trajectory of weight in Veterans in addition to lifestyle changes,” said Aleman.
The study examined data for 43 local Veterans who were enrolled in the NY-MOVE! weight-loss program and who were prescribed an obesity medication. The most commonly prescribed medications at the local level were metformin (Glucophage), liraglutide, and phentermine/topiramate.
Researchers review records of nearly 600,000 Veterans
The research team wanted to know how well the local group of Veterans were doing in comparison to the larger VA population. Aleman’s team reviewed nearly 578,000 VA health records nationwide for Veterans who had an obesity diagnosis or metformin prescription in their VA health record. Metformin is a commonly prescribed diabetes drug that can help with weight loss.
In comparison to the New York group, the national group of Veterans had greater numbers of men, were less racially diverse, and were later in their disease progression – 86% had type 2 diabetes, compared with 44% of the local group.
On average, the New York group lost 8.8 pounds over the initial six-month period. Over a one-year period, 75% of the national group lost between 5.5 to 11 pounds after starting weight-loss medication.
Don’t do it alone
Diet and exercise are typically first-line treatments for weight loss. In the case of Veterans, Aleman says excess weight may be related to the lack of structure they encounter after their military service is over. That is why the VA-MOVE! Weight Management Program is designed to reintroduce structure for Veterans.
VA-MOVE! makes use of behavioral interventions, like group counseling, with lifestyle guidance and nutritional education. The program offers Veterans a range of tools – for example, food journals, a mobile app to track diet and exercise, and, in some cases, access to gyms.
Studies have shown that participants in VA-MOVE! typically achieve modest, short-term weight loss – with an average of 0.28 lbs. to 7.3 lbs. at the one-year mark. Aleman says a typical weight-loss goal might be losing 5% of your baseline weight within 3 to 6 months. For a 200-pound Veteran, that would be 10 pounds.
“I tell my Veteran patients that even though it doesn’t sound like a large amount of weight, it is the type of weight loss that tends to be sustainable. It will also help with health complications, which is really the goal,” said Aleman.
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