How to Pick the Best Weight Loss Medication

Posted: Oct 22 in Weight Loss Medication by

Which weight loss medication is right for you?

Perhaps one of the most frequent questions I get every day is around trying to pick the best weight loss medication. These days, there are many more and better options than just a few years ago. I had the pleasure of hearing an expert from Mayo Clinic, Dr. Andres Acosta, present on this topic at the Obesity Medicine Association Conference.

Dr. Acosta has been studying people’s responses to medications, and has developed a framework to help get people on the best medication. In his research, he has identified 4 general “obesity phenotypes.” He calls them: hungry brain, hungry gut, emotional hunger, and slow burner.

Hungry Brain

Somebody with a hungry brain thinks about food a lot and has excessive hunger.

Hungry Gut

Somebody with a hungry gut eats, but then the food passes through the stomach very quickly, so the person feels hungry again soon after eating.

Emotional Hunger

Somebody with emotional hunger eats due to a variety of emotional cues – stress, anxiety, etc. This tends to be in the evening, and tends to be a specific food.

Slow Burner

A slow burner is somebody with a slow metabolism. This can be measured by calorimetry, indirect calorimetry, or estimated with formulas and/or body composition


Some people have multiple obesity phenotypes

obesity phenotype graphic explanation

Picking the best weight loss medication

If we can hone in on what type of hunger you have, we can tailor treatment. For example, hungry brain responds better to phentermine / tenuate with or without topiramate combined with lifestyle interventions. Hungry gut responds better to the new injectable GLP-1 anti-obesity medications like Saxenda and Wegovy (or Ozempic), or the new Mounjaro. (Read more about the GLP-1 weight loss medications here). Emotional hunger responds better to Contrave. And for the slow burner, phentermine/tenuate with or without topiramate combined with working with a personal trainer on increasing muscle mass.

In his study (click here to see the study), he showed significantly improved weight loss when the right weight loss medication was selected.

Which weight loss medication is right for you? Dr. Lazarus and Heather Thomas, PA-c would be happy to help guide you!

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