The journey to managing weight and achieving a healthy lifestyle often involves exploring various options, from lifestyle adjustments to medical interventions. This article delves into several weight loss approaches, including pharmaceutical options like retatrutide, medical programs such as Red Mountain Weight Loss, and considerations for individuals with specific health conditions.
The Role of BMI and Overall Health
Maintaining a healthy weight is crucial for overall well-being. For men, a healthy Body Mass Index (BMI) can positively impact fertility by ensuring sperm quality. For women, while many with a high BMI experience uncomplicated pregnancies and healthy babies, a higher BMI can increase the risk of complications. It's generally advisable to address excess weight before pregnancy, as dieting during pregnancy can deprive the baby of essential nutrients. However, if you are overweight when you get pregnant, try not to get overly worried. Focus on staying active and maintaining a healthy, balanced diet. A BMI over 30 may lead to more frequent prenatal appointments due to increased risk factors.
The reasons behind weight gain are multifaceted, encompassing emotional eating, underlying medical conditions, and medication side effects. Some medical conditions can cause fertility problems or problems during pregnancy. Certain medications, like antipsychotics used to treat schizophrenia, bipolar disorder, and severe depression, can contribute to weight gain by increasing appetite and causing fatigue. If medication-induced weight gain is a concern, consulting a doctor about alternative prescriptions may be beneficial.
For those trying to conceive, prioritizing mental well-being is important, and support is available if needed. Setting realistic goals, such as reducing BMI by a couple of points, can provide a tangible target to work towards.
Lifestyle Changes and Medical Support
Sustainable weight loss is best achieved through gradual lifestyle changes rather than drastic measures like crash diets or excessive exercise in short periods. Consulting a General Practitioner (GP) can provide valuable guidance on lifestyle adjustments and dietary improvements. Your GP can tell you about local weight loss groups available. These could be provided by the local authority, the NHS or a private company service, which you will need to pay for. They may also offer referrals to a dietitian for personalized advice.
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Red Mountain Weight Loss Program
Red Mountain Weight Loss is a chain of medical weight loss centers located across Texas and Arizona. This program emphasizes a personalized approach to weight management, beginning with a comprehensive medical examination to understand the underlying reasons for a patient's weight issues. "All of our patients are overweight, but the reasons for it are very diverse,” says Dr. Bentz. “We take a full history and have to be an investigator and dive in to figure out what are the patient’s problems. Why are they overweight? What is their lifestyle like? What things are difficult for them? How are we going to help them?”
The Red Mountain Lifestyle program focuses on a diet plan tailored to individual nutritional and caloric needs, lifestyle, and activity levels, providing macronutrient guidelines to follow. The RM3 program is more intensive, incorporating a customized diet plan, patented medication, weekly shots, and supplements. The ingredients in their proprietary products include vitamins, minerals, amino acids, and things that support your own body’s metabolism and energy levels and help to inhibit cravings and appetite. Plans range from $200 to $500 per month. Patients can drop an average of 10 or 20 pounds per month. Red Mountain lets you eat normally. “Our programs all consist of real foods that patients are buying from the grocery store because we want to make sure that they know how to eat for life,” says Dr. Bentz.
Pharmaceutical Interventions: Retatrutide and GLP-1 Agonists
The field of weight loss medications has seen significant advancements with the emergence of GLP-1 agonists, which mimic a hormone that helps reduce food intake and appetite. Semaglutide, found in Ozempic and Wegovy, is one such example. Eli Lilly's tirzepatide acts as a GLP-1 agonist and mimics another hormone, GIP.
Retatrutide, an experimental drug from Eli Lilly, has shown promising results in clinical trials. In a mid-stage clinical trial, participants taking retatrutide experienced an average weight loss of about 24% of their body weight, equivalent to approximately 58 pounds. Retatrutide mimics GLP-1 and GIP, plus one other hormone: glucagon. GIP is thought to improve how the body breaks down sugar; glucagon may reduce appetite and help metabolism run more efficiently. “This can explain why retatrutide yields more effective weight loss,” said Dr. Holly Lofton.
The phase 2 trial involved 338 adults with obesity or overweight, with participants having a BMI of 27 or greater. The drug was administered as a weekly injection. After 24 weeks, patients taking the highest dose lost, on average, 17.5% of their body weight, the equivalent of, on average, 41 pounds, according to the company. By 48 weeks, the weight loss increased to 24.2% of their body, or 57.8 pounds.
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Weight loss in the trial seemed to happen quicker than other weight loss medications. Novo Nordisk’s semaglutide was found to reduce body weight, on average, by around 15%, or about 34 pounds, after 68 weeks. And Lilly’s other weight loss drug, tirzepatide, was shown to reduce body weight, on average, by 22.5% on average, or about 52 pounds, after 72 weeks.
Like other weight loss medications, retatrutide may cause side effects such as nausea, vomiting, diarrhea, and constipation. These side effects are often experienced as the dosage is increased at the start of treatment and tend to subside with continued use.
Considerations for Specific Health Conditions: Crohn's Disease
Weight management can be particularly challenging for individuals with chronic conditions like Crohn's disease (CD). Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high‐risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de‐escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations. Withdrawal of immunosuppressant and biologic drugs in patients with quiescent CD may limit adverse events and reduce healthcare costs.
Immunosuppressant drugs (e.g. azathioprine, 6‐mercaptopurine and methotrexate) and biologic medications (e.g. infliximab, adalimumab, vedolizumab and ustekinumab) are commonly used alone or in combination to treat Crohn's disease. While effective for initially controlling disease, long‐term exposure to these medications carries risks, including infections and certain types of cancer.
A review of six randomized controlled trials (326 patients) evaluating therapeutic discontinuation in patients with quiescent CD were eligible for inclusion. In four RCTs azathioprine monotherapy was discontinued, and in two RCTs azathioprine was discontinued from a combination therapy regimen consisting of azathioprine with infliximab. The effects of withdrawal of immunosuppressant therapy in people with quiescent Crohn's disease are uncertain. Low quality evidence suggests that continuing azathioprine monotherapy may be superior to withdrawal for avoiding clinical relapse, while very low quality evidence suggests that there may be no difference in clinical relapse rates between discontinuing azathioprine from a combination therapy regimen, compared to continuing combination therapy. It is unclear whether withdrawal of azathioprine, initially administered alone or in combination, impacts on the development of CD‐related complications, adverse events, serious adverse events or withdrawal due to adverse events.
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