A Coach’s Thoughts On Obesity Medications

Over the last couple of years, you’ve likely heard about the popularity and increase in use of obesity medications.

While the medications themselves are not new and variations have been around for decades, some names are coming up with greater frequency due to how effective they are and in who is getting access to them.

As one might imagine, everyone has an opinion (including myself) and I wanted to compile some thoughts here as a way to approach their usage from the most considerate and respectful place possible.

Allow me to start here with a bit of background on myself. I own a brick and mortar personal training facility where I’ve worked with individuals of all body types for the last 14 years. I also am an online nutrition coach where the last year and a half has given me the greatest exposure to clients who take these medications.

Here is something I’d like to pose to all of the coaches who may be reading this article. I’d like you to think about every person who you’ve worked with who came to you for fat loss and was either A) unsuccessful at losing fat or B) losing fat and keeping it off.

I know that’s a loaded statement.

Sadly, there are coaches in this industry who think that an individual’s ability to be successful at fat loss is due to lack of motivation and/or lack of willpower. The kind part of me thinks that they just need to spend a bit more time working with a greater variety of people so they can develop more understanding and empathy to change their minds.

The not so kind part of me thinks that maybe they’re just assholes. (I might be right on both accounts).

The fact is, even I can admit that clients have come to me for fat loss and have been unsuccessful with their goals and that could be for a host of reasons: 1) They didn’t resonate with my approaches 2) They had too many competing interests for their goals 3) They just “weren’t ready”, etc.

Many coaches start in this field because of their own fat loss transformation story.

Take Joe Trainer who identifies as being the “chubby kid” who was bullied in high school and college, got sick of the insults and shaming, found the gym, lost XXX pounds, looks fit as can be, and wants to bring everyone else to the Promised Land because discipline, hard work, motivation and persistence got him to the body he wanted.

That’s not my story and while there is certainly nothing wrong with discipline, hard work, motivation and persistence, what Joe Trainer conveniently forgets to share with people is that while he was working on having the body of Adonis he was young, he was single, he was only responsible for a car payment and he had no kids.

Joe Trainer also likes to forget that there is a significant genetic/biological component to an individual being overweight and while, yes, some people can grit their teeth and grind their way to the body of their desire, MANY people will NOT be able to take this approach.

As my friend and mentor, Dr. Spencer Nadolsky, has told me (paraphrased): In a perfect world, all it would take is a diet and exercise intervention and everyone would get their desired results. We don’t live in that world.

As a coach, I might (and do with frequency) come across an individual who struggles with depression. While I know that there can be mood-lifting benefits to a healthy diet and that exercise can be tremendously beneficial for mental health, I would NEVER tell someone to give up their Prozac because superfoods and kettlebells can cure their depression. All of these interventions can play nicely together to allow someone to live their best life.

Of note, many people pursuing fat loss elect to have bariatric surgery. What is not commonly discussed is that a significant portion of those individuals regain weight even after the tremendous success of that surgery. And why is that? Well, the surgery may have decreased the size of their stomach but it didn’t change the brain.

And what drives the decisions for what we eat and don’t eat and whether we decide to move or not move? The brain.

Which is why, even with the initial success of the bariatric surgery, many patients also look to obesity medications to help them keep the weight off.

At it’s simplest function, obesity medications help reduce hunger. They do more than that, of course, but this is the way I’d like you to think about it.

As a coach, I’ve had clients swear to me as the day is long that they are consuming XXXX amount of calories religiously and they can’t lose fat. Now, I may know that there is no way they can defy the laws of physics but I’m also not going to run around calling people liars either. That’s not good business (or good peopling).

It’s my job to understand if and where underreporting is happening and to try my best to help clients get the right energy deficit to see results.

The medications, essentially, force the deficit.

So, what are the downsides? There are potentially several. Cost, availability, side effects like nausea or dizziness, and the consideration that many people may have to stay on the medications indefinitely (albeit at smaller doses).

The sad fact is, in the U.S., medications of many varieties are terribly expensive. My mother has Type I diabetes and insulin shots certainly aren’t cheap. Perhaps some of these things will change over time as more options become available but right now, if insurance does not cover the cost of obesity medications, it could be cost prohibitive.

The other problem is that many people who do have discretionary income are able to pay for the medications out of pocket simply to lose some vanity weight. That demand shortens the supply for those who actually NEED the medication.

The other concern is that, with dramatic fat loss, comes the potential for dramatic muscle loss as well. This, of course, is not good. If you currently take these medications, please start (or keep) lifting weights. Your body will thank you.

And this is where I think many coaches need to realize their place in the discussion.

Just because someone elects to take an obesity medication doesn’t mean they don’t need to learn healthier lifestyle habits, the importance of resistance training, the importance of a high(er) step count, having productive coping skills, or how to make nutritious food choices.

Remember: the medications force the deficit. Everything else that matters for improving one’s health still may need support and interventions.

Unfortunately, many coaches view obesity medications as a threat to their income. It isn’t. It’s a complement (just like an antidepressant).

The other thing to note is that these medications will not ever go away. They will increase in efficacy and availability and likely with fewer negative side effects. The sooner we (as a collective whole) can respect their place in the discussion, the sooner we can embrace our client’s needs to utilize them.

This article is not meant to diagnose or replace the advice of your physician. If you believe you are or could be a candidate for obesity medications, please consult with a general practitioner for more information.

(Photo courtesy of Diana Polekhina)