Re-assessing Weight Loss Goals

Posted: Mar 28 in Weight loss, Weight Loss Medication by Dr. Lazarus

Most people I work with have a goal to lose a certain amount of weight, to “get back” to a previous weight from our past, often a high school or college weight.

It seems like every day, there is a new TikTok, Instagram or Facebook story about a movie star who lost 50 pounds with some amazing new too-good-to-be-true treatment.

But the fact is, we should all know better than to believe everything we hear on social media. Most people do not in fact return to their high school weight. Instead, let’s look at the evidence behind different weight loss treatments – then we can set a goal based on the treatment selected.

Current anti-obesity treatment success is measured by percentage weight loss, not by setting “weight loss goals” per se. For example, if a person is 200 pounds, and they choose a treatment offering 10% weight loss, they would lose ~20 pounds, down to ~180 pounds. More importantly, we also need to discuss ways to sustain the weight loss.

Percentage Weight Loss by Intervention Type

1. Lifestyle Programs: ~5%
   Lifestyle interventions include structured food plans, behavioral visits, and physical activity counseling. Sometimes these are in-person, sometimes virtual or even via a phone ap. Examples could include things like Weight Watchers, Jenny Craig, Noom, MyFitnessPal, etc. While some may lose a lot more, evidence suggests lifestyle interventions can help a person lose around 5% of their body weight. (10 pounds for a 200 pound individual)
2. Daily Medications: ~10%
   There are many oral weight loss medications including: Phentermine, Tenuate (diethylpropion), Contrave and Qsymia. Although there are small variances between trial results, a reasonable goal would be 10% weight loss on an oral medication. Saxenda (daily injectable) also offers ~10% weight loss. (20 pounds for a 200 pound individual)
3. Weekly Injectable Medications: ~15-20% weight loss
   Wegovy, our first weekly injectable anti-obesity medication, offers 15-20% weight loss. (30 pounds for a 200 pound individual, 35-42 pounds on average in published clinical studies)
4. Future Medications: 20% (or more)
   Medications in development may offer 20% weight loss or more. In clinical trials, Mounjaro took off an average of 50 pounds. It is being reviewed by the FDA in its application for chronic weight management.
5. Weight Loss Surgery: 25-33%
   Gastric Bypass and Sleeve Gastrectomy can help people lose ~30% of their body weight, with a sustained weight loss reported as 25% in clinical studies.

Note that weight loss from the different approaches can be additive – for example, an intensive lifestyle program + an oral medication may provide better results than either method alone. Also, weight loss is only sustained if the treatment is continued – there would be no sustained weight loss from a medication if that medication is stopped.

While it is important to know study results, keep in mind that some patients lose a lot more than the above stated percentages. Of course, for some weight loss is a real challenge and they lose less.

Now that you understand the expected result from different treatment options, you can make a more educated decision for which treatment is best for you.