A charming 58-year-old women walked into my office. She was successful product manager, a mother of 3, and looking for answers. Her co-worker recently lost 60lbs by going on a low carb diet augmented with FDA approved anti-obesity medication called Contrave(naltrexone/bupropion). She spent $200 on medication per month as it was not insurance covered and followed the same diet. After 4 months, she had gained 4lbs ! Despite her track record of being wonderful person, she internalized this as failure. It was her fault- she failed the program and medication. The reality though is her results were just as likely and expected as her co-worker.

When it comes weight loss we get flooded with averages. We get information from op-eds, articles, and short news segments that highlight key findings from new studies. But beyond the tag-line and summary findings lies a wealth of data showing that only constant when it comes to weight loss is variability. That you as individual will have a wildly different response to weight loss intervention than your siblings, friends, or co-workers. We are all inundated with new blurbs like the following:

Study backs low carb diets…Stanford University researchers comparing three popular diets for a year found that overweight women lost the most weight on the low-carb, high-protein Atkins diet. – Mercury News March 6th, 2007.

A study in 2007 done at Stanford University compared the effectiveness of four diets against each other (Atkins, Zone, Learn, and Ornish). It reported that Atkins diet had almost double the weight loss (~10lbs vs ~5lbs) at 12 months than the other 3 diets. What are we going to do after reading the above tag-line… Go on low carb diet!!! I am personally starting tomorrow.

The problem with this mentality is the study also showed that Atkins diet may not be for you. Within each diet group, there were some people who lost as much as 20kg (~45lbs) while others gained as much as 5 kg (10lbs). If your the individual who gained 10 lbs on the Atkins diet or the person who lost 50 lbs on the Ornish diet you’re going to have hard time arguing that Atkins diet is the way to go.  The variability in outcomes is a hallmark of obesity whether it’s diet, exercise, medications, procedures, or surgery. It is super frustrating and as of yet, there is no escaping it.. This should change the way we evaluate which diet, program, or therapy we choose.

untitled
Which Bar Line Are You?

By adding CONTRAVE to your weight-loss plan for a full year, you could lose approximately 2-4x more weight than with diet and exercise alone. 

That is how the medication Contrave is advertised. It sounds good and it’s 100 percent true depending on who you are. A study in Nature on Contrave showed that while the average weight loss was roughly 7-8% (roughly 15-20 lbs for most Americans), some individuals achieved as high as 40% weight loss while other gained up to 5%. Let’s edit the above tagline to capture this.

By adding CONTRAVE to your weight-loss plan for a full year, you could lose as much as 60 lbs or gain as little as 10lbs.

Clearly, your decision to take medication to help treat your obesity depends on the benefits you’re getting. If you lose 10%, 15%, or more, the medication is a godsend- it likely will prevent you from taking 4-5 future medications. If you lose less than 5% or gain weight- well, you’ve only added to your health risk. If only there was a way to tell if you had the type of obesity that Contrave really treats? That is where precision medicine will hopefully take us one day. And yes I do think there are indeed several different obesities ( an idea to explore later).

ijo201667f2
Contrave (NB) vs Placebo (PBO)

Any weight loss expert, program, or clinic that only offers one type of intervention or diet is failing to acknowledge the one thing we know about weight– that there is no one size fits all when it comes to obesity. You have to find your own path and this takes a lot of hard work. At Enara we try to take some of the guess work out of this process. But before we get there, let us first decide if we need to lose weight in the first place. More to come on that soon!

Posted by:Dr. Rami Bailony

Dr. Bailony completed his medical school and internal medicine training from UCSF. Thereafter, he went on to complete a fellowship in Healthcare Innovation with Medicine X at Stanford University where he focused on behavioral change, obesity and diabetes management. From there he went on to co-found Enara Health and Enara Health Group which uses online and mobile platforms to provide clinical programs for obesity and type II diabetes.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s