By Caroline Cederquist, M.D.

What’s New in 2019 in Weight Management1. New Medication Options for Weight Loss
Twenty years ago, I opened Cederquist Medical Wellness Center, with the objective of providing comprehensive medical weight management care. This was one year after the medication fenfluramine was taken off the market because it caused heart problems in some people who took this medication as part of the phen-fen diet pill combination. There was much caution and concern about using medication for weight loss as the medications available for use twenty years ago were mostly stimulants distantly related to amphetamine.

In the past five years, several medications were approved by the FDA for weight management to be used along with diet and lifestyle changes. Qsymia, Contrave and Belviq are medications taken by mouth that all work in the brain to suppress appetite or cravings. Saxenda is an injectable hormone that also works to suppress appetite. Vyvanse is a medication approved for binge eating disorder, not weight loss, but control of binge eating disorder often leads to weight loss in those affected by it.

2. Specific Nutritional Approaches for Metabolic Conditions
Dietary change has been and remains the safest and most effective weight management tool and our center has always had three full time dietitians on staff. Everyone needs to be mindful of calories regardless of weight concerns, because there are so many ways more calories are creeping into our lives such as with “dessert coffees” which were not so conveniently available even twenty years ago. Also, the proportion of meals eaten away from home continues to rise and those meals usually come with larger portions and more calories. However, in over twenty years of clinical practice, I’ve witnessed that counting calories and eating less does not always provide the weight loss results expected.

The recognition of an important but not often diagnosed metabolic condition known as insulin resistance has really been impactful in helping people lose weight. The vast majority of my patients have evidence of insulin resistance, which is a condition of dysfunctional blood sugar regulation. When it is present, energy does not enter the cells properly so the cells are effectively starving and at the same time, the energy that can’t enter the cells is stored as fat. This common condition can be reversed with the right meal plan, one with adequate protein and high fiber but still controlled in total fat and carbohydrates. When this condition is more advanced, some herbal supplements like berberine or the diabetes medication metformin can be useful adjuncts to treatment.

Another metabolic condition important for successful weight management is optimal thyroid function. One of the most common causes of underactive thyroid function is an autoimmune condition called Hashimoto’s thyroiditis. In this condition, the immune system attacks the thyroid gland. There are many reasons why our immune system may attack our own bodies and being able to determine some of these reasons and intervene to stop further damage, is vital to improved health and better weight management. Some of our patients have food sensitivities and determining and removing these inflammatory foods can decrease the overall inflammatory and autoimmune response.

3. Determining Your Specific Lifestyle Reasons for Weight Gain
Weight gain occurs for so many different reasons, not simply from eating too much and exercising too little. Determining why weight gain is occurring and appreciating that there are many contributors is imperative. The lifestyle contributors include stress, poor sleep, environmental pollution, more

sedentary lives or an inability to exercise. Our lives are complex and eliminating stress is unrealistic. We are also learning that more and more chemicals that are ubiquitous in our environment affect our metabolism. What we can do is improve our own rejuvenation and detoxification ability by focusing on improving rest and sleep and seeing where we need more nutritional support for our unique detoxification ability.

4. Investigating the Role of Our Individual DNA
Looking at our unique detoxification pathways brings us to studying our individual DNA patterns. There has been great interest in looking at single nucleotide polymorphisms called SNPs (pronounced “snips”) which are the most common type of genetic variation among people and how a diet, exercise or detoxification plan can be tailored around this information. One example is that people with a certain SNP will absorb more fat from higher fat diets than other people do, so the trending popular ketogenic diet would not be a good idea for people with this SNP. People with another SNP may develop more inflammation if they do high intensity interval training and hence need a different program. We can also identify people who are likely to metabolize certain toxins much more slowly and we can use certain nutrients or supplements to boost detoxification ability.

Comprehensive weight management continues to evolve and its present and future is in individualized investigation and treatment plans.

Cederquist Medical Wellness Center

1575 Pine Ridge Road
Suite 19
Naples, FL 334109