Weight Loss and my thoughts on "Pellets", Exercise, Nutrition and Medical Weight Loss - Linda Winegardner MD

You have taken an important step using hormone replacement therapy to fight aging and address symptoms that impact your quality of life.  There are so many benefits to compounded bioidentical "pellets".   Balancing hormones is a way to change our bodies back to a pre-menopausal state.  Menopause/Andropause is not kind and leaves women with a  "menopausal apron" and round midsections in men.  We also experience a loss of muscle tone.  My "pellet" patients should see improvements in these symptoms after the second or third pelleting though meaningful weight loss may require additional effort and/or medications.

Hard Truth.  Losing and maintaining weight requires a commitment to a life style that manages exercise, caloric intake, and nutrition.  Medications can help achieve initial weight loss but lifestyle changes are what it takes to keep that weight off.   

Compounded Bioidentical Pellets and Exercise.   How do the pellets help you lose weight?  Most of my patients who are on "pellets" state they feel better, are less fatigued and free of the symptoms for which they sought relief.   This positive energy motivates many to exercise more.  The bioidentical testosterone pellets help tone and build more muscle. The body hangs onto fat when the hormones are depleted so HRT will also help in this way. Your metabolism is higher with exercise and improved muscle tone which means more calories are burned.   If your caloric intake is below what is required to maintain your weight, YOU WILL LOSE WEIGHT!  It is that simple for most people.   Here is a link to a  very helpful Calorie Calculator.  Note that it has values to "Maintain weight" and for losing 1/2,  1, and 2 lbs. a week.   The 2 lbs. a week goal may be hard for some.  Try a lesser goal to make your weight loss more achievable. 

Caloric intake and Nutrition.    Most of us do not realize how many calories we are actually consuming.  I hear from patients all the time “I eat almost nothing but still can't lose weight!"  If you are obese (BMI over 30), this may be related to "insulin resistance" or "metabolic syndrome".   These medical conditions may be managed by medications.  They both are also treated and prevented through nutrition, weight loss and exercise. 

You must be "calorie conscious"!  Be aware of portion sizes. When eating out a majority of restaurants have calories posted besides the entrees.   Not only become "calorie conscious" but have a way to track your calories. In the past we would give a paper diet diary for patients and tell them to record everything. Now things are much easier with phone applications. On the Apple I-Phone there is an app called Fitness Pal. The free part of it is fine; no need to upgrade.  Androids have a similar App. As you sign up it will ask for your weight loss goal over a certain period of time.   A nice feature of Fitness Pal is most of the brands of foods AND fast food and restaurants are listed.  You can also add your daily workouts.  At the end of the day, when you hit COMPLETE it will tell you what you are on track to doing.   For example, "IF YOU DID THIS EVERY DAY IN FOUR WEEKS YOU WOULD WEIGH….".  It also does a warning when your entries are high in fat or carbs. 

When I first started using Fitness Pal,  I was floored to learn I had used up my daily calories by lunch time!   There are  a wide variety of diet snacks that are high in protein and low in carbs to help you fight hunger and still have adequate nutrition.   

Junk food needs to go!  Not only are they empty calories but most likely high in carbs. Carbs cause a retention of fluid as well as abdominal bloating and fat. Pass on those sweets and extra bread. Think in terms of a low carb diet (complex carbs from plants are good).  Don’t have your favorite junk food around because we all have that weak moment.  Have something healthier like carrot sticks etc.  Once you remove those things from your diet you will not miss them and will feel yucky when you eat them again.    Beverages such as sweet tea and juices have a lot of sugar so therefore a lot of calories.  Try using sugar substitutes such as Stevia. 

Alcohol has been the source of weight gain for many of us.  Excessive alcohol adds empty calories and increases the risk of chronic disease or cancers.  Sad to say but more and more studies recommend zero alcohol in your diet. 

Exercise and a healthy diet are critical to sustaining and enhancing your health. Here are some diets to consider:

Mediterranean diet https://www.healthline.com/nutrition/mediterranean-diet-review-scored

5:2 diet https://www.healthline.com/nutrition/the-5-2-diet-guide#TOC_TITLE_HDR_8

Slimming World https://www.healthline.com/nutrition/slimming-world-diet#weight-loss

Mayo Clinic diet https://www.healthline.com/nutrition/mayo-clinic-diet

DASH (hypertension) diet https://www.healthline.com/nutrition/dash-diet

Ok, enough on exercise and nutrition.  You have gone there, got the T-shirt and still haven't lost the weight!  How about bariatric surgery?  How about weight loss medications?

Bariatric Surgery.  Bariatric surgery offers the greatest opportunity for major weight loss but is intended for those with a BMI of greater than 40.  I have seen very few long term success stories related to bariatric surgery - So many side effects and so little to show for it in most cases.   Having said that, please consult with your primary care provider to see if bariatric surgery is an option for you. 

There are new options for obesity and significant weight loss that do not require surgery. 

Medications for Weight Loss. 

The standard go to medication for weight loss is phentermine (Adipex-P, Topamax).  Why?  Because in its generic form it is cheap and covered by most insurance assuming the patient has met some minimal requirements.  It is an appetite suppressant that also increases metabolism.  Results?  5-10 lbs. weight loss.  Side effects may include elevated heart rate, sleeplessness, nervousness, and constipation.  There are several health conditions that prevent some patients from using this medication.  Most patients gained the weight back.  Once again, life style changes are key to maintaining weight loss.

There are others such as Xenical, Contrave, Qysmia, and Saxenda that most insurance will not cover without a "prior authorization" which means the patient must meet certain requirements.   They are expensive and most work thru the basic concept of decreasing appetite and by making you feel full sooner.   

A relatively new class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists originally developed to treat type 2 diabetes, has been found to also treat obesity.   Examples of these medications include Ozempic and Mounjaro.  Wegovy and Zepbound are the same medication but approved for treating obesity.   The generic version of Ozempic and Wegovy is known as semaglutide.  This medication works by targeting your brain (GLP-1 receptors) to regulate appetite, helps your pancreas produce insulin when blood sugar is high, helps prevent your liver from making and releasing to much sugar, and slows down food leaving your stomach.  The results for those wishing to lose weight on these medications has been dramatic.** 

Name brand medications Ozempic, Mounjaro, Zepbound, and Wegovy are in high demand and supplies are limited.  The patent holders of these medications - Novo Nordisk and Lilly - are unable to meet the demand.  Hence there is a shortage.   The medications have proven themselves to be "game changers" for diabetes care and for the treatment of obesity.   The Food and Drug Administration have recognized the value of the medication and placed these medications on a "shortage" list which allows it to be manufactured outside the patent holders jurisdiction  going by its non-branded names - semaglutide and terzepitide.  This  situation allows medical practices like ours to purchase this medication at a much lower cost than the branded medications and that is what we are doing.

Weight Loss and HRT.   We are offering Semaglutide to our HRT patients as long as it is available to us to purchase.  Ask me if you are a candidate for this non-branded version of Ozempic.   It is not covered by insurance but is much less expensive than the branded versions.