When you think about boosting metabolism or managing the health issues that stem from obesity, you probably don’t think about hormones. But endocrinology – the branch of medicine dealing with hormones – can play a key role in evaluating and addressing obesity to improve metabolic health.
At Holland Hospital Endocrinology, Karl Nadolsky DO, board-certified endocrinologist and obesity specialist, helps patients improve their health while emphasizing that it is quite literally what's on the inside that counts.
“Teaching people to optimize their nutrition and exercise goes beyond just losing weight,” said Dr. Nadolsky. “That said, we know that losing even a little bit of excess weight markedly improves health.”
What is obesity?
“Obesity is excess or abnormally-distributed fat tissue that causes health problems,” said Dr. Nadolsky.
Each person’s weight is the result of a complex blend of genetic predisposition, different food environments and upbringings, medical conditions and medications. “Weight loss is not as easy as ‘eat less, move more’,” said Dr. Nadolsky.
Metabolic health issues typically arise when the body stores excess fat in areas like the liver, muscle cells and pancreas. These issues include type-2 diabetes, fatty liver, high blood pressure and increased cardiovascular risk while excess weight overall can lead to sleep apnea, cancer risk and knee arthritis.
“Those things grade the severity of the obesity, not just someone’s weight,” said Dr. Nadolsky.
Weight loss medications
It’s difficult for the average person to lose more than 3 to 5 percent of their weight simply through nutrition and exercise. A “set point” in part of the brain called the hypothalamus fights weight loss by increasing appetite and lowering metabolism.
In light of this, certain medications can help people reach clinically-beneficial levels of weight loss of more than 10 to 15 percent of their weight. These medications help suppress appetite and are prescribed alongside a nutrition and exercise plan under the guidance of a medical practitioner. They include:
- Phentermine
- Qsymia (phentermine + topiramate)
- Contrave (buproprion + naltrexone)
- Orlistat (reduces fat absorption as opposed to appetite reduction and can be prescribed as Xenical or purchased over the counter as Alli)
- Plenity (a super absorbent hydrogel that takes up space in the stomach)
GLP-1 receptor agonists
Another kind of weight-loss medication is currently receiving a lot of public attention: GLP-1 receptor agonists. These medications improve pancreatic function, slow stomach function and improve satiety. Some have been approved to treat type-2 diabetes (T2D) for 15 years, and the FDA has recently approved some for weight loss. These daily or weekly injections include:
- Victoza (liraglutide, FDA-approved for T2D, not FDA-approved for weight loss)
- Saxenda (liraglutide, FDA-approved for weight loss)
- Ozempic (semaglutide, approved for T2D, not FDA-approved for weight loss)
- Wegovy (semaglutide, FDA-approved for weight loss)
- Mounjaro (GLP-1/GIP agonist approved for T2D, not yet FDA-approved for weight loss although it is expected to be soon)
Last year, due to popularity and manufacturing issues, there was a shortage of these medications. “People who don't really need them are using up these medications while people with severe disease need them,” said Dr. Nadolsky
Dr. Nadolsky also warns against the use of cheap, compounded versions of these medications that are not FDA-approved but often purchased through “clinics” that raise red flags of skepticism.
Lifestyle medicine
Dr. Nadolsky is a big proponent of lifestyle medicine, a medical approach that seeks to prevent and treat chronic disease by changing habits and behaviors.
Nutrition, sleep and exercise play key roles in lifestyle medicine. Many patients can change their energy intake simply by minimizing processed foods and eating more whole foods. And while exercise is not typically an effective way to lose weight on average, it is very important for health.
Lifestyle medicine is a critical part of a range of treatment options that Dr. Nadolsky uses to address obesity and improve health in order to find the best option for each individual patient.
Where can I learn more?
Holland Hospital Endocrinology offers comprehensive diagnosis, treatment and management of all endocrine and hormone-related conditions. Talk to your primary care provider about a potential referral to Holland Hospital Endocrinology. To schedule an appointment with Dr. Karl Nadolsky, call (616) 395-2833.