Treating obesity is a multidisciplinary process. It requires a combination of a balanced diet and regular physical activity, along with an understanding of how obesity affects various organs and body systems. Using medication without lifestyle changes is not recommended and is often linked to treatment failure.
Health Conditions to Assess First
Before starting weight loss treatment, your GP will screen for co-morbidities and target-organ damage. Your GP will assess and manage any of the conditions listed below before proceeding with treatment. A formal consultation is necessary to evaluate these and create a safe and effective plan.
Genetic Obesity
Obesity that begins before the age of five or is strongly present in first-degree relatives may have a genetic cause. In these cases, your GP may recommend further testing for conditions such as leptin deficiency or Prader-Willi syndrome.
Hypothyroidism
An untreated low thyroid hormone level can lead to weight gain and may also cause weight loss efforts to be less effective. This condition should be checked and corrected before starting treatment.
Type 2 Diabetes (T2DM)
Diabetes can contribute to weight gain. Your GP will treat it in conjunction with any weight loss plan. They may prescribe medications that improve blood sugar control and help support modest weight loss.
Polycystic Ovary Syndrome (PCOS)
Women with polycystic ovary syndrome are sometimes prone to weight gain. Treating PCOS and screening for prediabetes is essential. In some cases, treatment with contraception or metformin can help with weight control.
Non-Alcoholic Fatty Liver Disease (NASH)
Non-alcoholic fatty liver is a major co-morbidity of obesity. Clinicians screen for signs of liver damage, including cirrhosis, and sometimes recommend treatment with cholesterol-lowering medication. Excessive alcohol consumption also damages the liver and increases the risk of complications.
Mental Health Conditions
Certain mental health conditions are more likely to be associated with weight gain, binge eating, and difficulty regulating urges. These include generalised anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and bulimia nervosa. It is better to address these first and make a plan with the mental health team before starting obesity treatment.
ADD/ADHD
People with ADD/ADHD may be more prone to changing eating habits, with or without medication. Some gain weight, others lose it. Balancing food intake and eating patterns is a crucial aspect of long-term ADD/ADHD management.
Other Contributing Factors
Your GP will also consider other factors that may contribute to weight gain before starting treatment.
Medication Side Effects
Several medications are associated with weight gain. These include corticosteroids, certain antidepressants and antipsychotics, lithium, some anticonvulsants, and some diabetes medications such as insulin, sulfonylureas, glitazones, and glinides. Depo-Provera may also contribute to weight gain in some individuals.
Rare Conditions
In rare cases, hormone-related conditions such as Cushing’s syndrome cause weight gain. A benign cortisol-secreting tumour often leads to this condition.
In Summary
Before starting weight loss medication, your GP will rule out and treat any underlying conditions that may contribute to your weight gain. This approach helps ensure the treatment is safe and effective.
In next month’s blog, I’ll explain weight loss medications in more detail and describe how they can support a comprehensive long-term management plan.
If you’re ready to take the next step, I run a dedicated weight loss clinic every Wednesday at Devonport Health Centre. Together, we can create a plan that suits your lifestyle and goals. Please speak to reception for more details.