TrueCare DPC
Restoring, preserving, and promoting health through
Direct Primary Care
Weight Loss is Medicine
Introduction
Let me ask you something: how do you feel when someone tells you, "You need to lose weight"? Does it trigger defensiveness or maybe some self-doubt? The topic of body weight has become incredibly sensitive these days, and that's a real shame. Why? Because body weight is a crucial aspect of our overall health. No. The number on the scale isn’t everything. And no, our body mass index (BMI) is not the end all be all of risk factors for chronic disease, but both of these are important data points that tell us information about our health. Unfortunately, many people link their body weight with their self-worth, making discussions about weight touchy and difficult. As a result, many miss out on the chance to make important decisions for their well-being.
As a medical practitioner, I've witnessed countless individuals feeling defeated by the weight loss journey. Considering the limited training primary care practitioners (PCPs) receive in helping patients with weight loss, coupled with the rushed clinical encounters, this isn't surprising. However, I've also seen how shedding those extra pounds can truly transform one's health. For me and my patients, weight loss isn't just about aesthetics. Sure, that's a bonus, but it goes far beyond appearance.
In this post, my goal is to provide motivation and perspective on weight loss by delving into how it can significantly impact your health. I'll be focusing on three common health issues I encounter frequently in clinic: type 2 diabetes, high blood pressure, and even depression. So whether you're here to gather tips for your own health journey or simply curious about the relationship between weight and wellness, stick around! Together, we'll uncover the incredible benefits of weight loss and how it can revolutionize your life in ways you may never have imagined.
Managing Diabetes
Let’s kick off our discussion by focusing on diabetes, specifically Type 2 Diabetes (T2DM). As a Primary Care Practitioner, it is crucial for me to understand the various types of diabetes, especially T2DM. According to the American Diabetes Association's 2021 report, around 11.6% of Americans (38.4 million) have diabetes,[1] with 90-95% having T2DM[2]. Thus, grasping key details about the disease is essential for effective disease management.
Now, to avoid the deep deep rabbit-hole of T2DM’s pathophysiology, I'll provide a link to a comprehensive study that lays out the latest scientific insights into how the disease happens. This same research formed the foundation for Lean et al.’s Diabetes Remission Clinical Trial (DiRECT) published in The Lancet in 2018. [3]
DiRECT was a small European study that included a total of 298 participants in the final analysis. I love this particular study because it set out to answer a very important question:
to assess whether effective weight management, delivered in the primary care setting, could produce sustained remission of type 2 diabetes.
Talk about a relevant research question!
So, how did the study unfold? Initially, participants were divided into two groups: the intervention group and the control group. The intervention group followed a strict 825–853 calories/day diet for three months, followed by a gradual reintroduction of food over 2-8 weeks. This was followed by a structured program for long-term weight loss maintenance, including monthly visits. The control group received standard care according to guidelines. The study lasted for 12 months.
What were the findings? In the intervention group, 24% of participants (36 individuals) lost a minimum of 33 pounds, while an impressive 46% (68 individuals) achieved diabetes remission, with 74% (109 individuals) no longer requiring antidiabetic medication. In contrast, no one in the control group achieved the same level of weight loss, only 4% (6 individuals) experienced diabetes remission, and merely 18% (27 individuals) discontinued antidiabetic medication—that is a big difference!
We can compare these results with recent real-world data regarding the efficacy of Ozempic in the treatment of T2DM. The results were presented at the 59th Annual Meeting of the European Association for the Study of Diabetes in October 2023.[4] This study encompassed data from 23,442 patients over three years, showing an average reduction in HbA1c by 0.77% and body weight by 10.36 pounds. And according to the graphs provided, none of the patients achieved remission of diabetes.
To clarify, I'm not claiming Ozempic doesn’t work and I’m not trying to discourage its use; in fact, I frequently prescribe it when appropriate. The point I’m really trying to make here is the profound relationship between weight loss and diabetes remission. In fact, I would argue that the magic of Ozempic is its ability to help improve weight loss for patients. While weight reduction, particularly fat loss, may not guarantee complete remission, it can significantly reduce the need for pharmaceuticals—a worthwhile goal in itself, as I often emphasize to my patients.
Managing Hypertension
Let’s move on to discuss elevated blood pressure, specifically hypertension (HTN). This is another very important medical condition that has a huge impact on our health. Estimates from 2017 to 2020 calculated that approximately 115.3 million (44.7%) US adults had HTN. [5] Like T2DM, HTN also increases our risk of heart attack, stroke, heart and kidney failure, and vision loss. [6]
So, what kind of impact can weight loss have on blood pressure? Well, let’s briefly look at some more data from the DiRECT study. Here we saw that there were 80 patients in the intervention group who were initially taking medication for blood pressure. By the end of the study, 38 had their medications withdrawn. Meanwhile, no one in the control group discontinued their blood pressure medication.
Then there’s Yang et al’s 2023 study published in the Journal of Clinical Hypertension. Theirs was a systematic review and meta-analysis ( a study of studies) that reviewed a total of 35 different studies for a collective 3219 patients.[7] They found that systolic blood pressure (top number on your blood pressure) was significantly reduced by 5.79 mmHg for every 2.27kg/m2 in body mass index reduction. In English, that means that if you were a 5’8” male who weighed about 180lbs and lost about 15lbs, you could see your systolic blood pressure go down by almost 6 points. Not surprisingly, they noted that the more your BMI went down, the greater the reduction in your blood pressure!
Now, don’t get me wrong, these results don’t really match up when compared to some of the most commonly prescribed antihypertensive. But when we consider common side effects of such medications [8] and any additional benefits from weight loss (think diabetes remission for some) you might see why I love to encourage patients to emphasize weight loss as a strategy for blood pressure management. In fact, if my patients are still at what we call stage 1 hypertension (top number between 130 and 139 mmHg and bottom number between 80 and 89 mmHg) I recommend at least a 3-month trial of weight loss through diet and exercise before starting them on medication.
Managing Depression
In addition to diabetes and blood pressure challenges, many of my patients often struggle with maintaining their mental well-being. Unfortunately, this is a common problem here in the United States. The National Institute of Mental Health reported that in 2021, at least 21 million adults (8.3% of adults living in the U.S.) experienced at least one major depressive episode.[9] And according to data from 2003, 60% of mental health care is given by primary care providers.[10] So, like diabetes and blood pressure, it’s important that I as a PCP appreciate the complexity of depression and depressed mood and the different ways that I can help my patients.
Now, in case you’re new here, you should know that I myself am not a big fan about the use of pharmaceuticals in the treatment of depressive disorders. In fact, you may have picked up on the fact that I’m not a fan of using pharmaceuticals in general if we can help it. I provide a detailed breakdown of why I have this stance regarding antidepressants in this article. And I always welcome an open discussion with patients about this.
But this article is specifically about the benefits of weight loss and here I’m talking about how it improves depressive symptoms. For that, I draw your attention to a 2021 study published in The Journal of Personalized Medicine that evaluated 24 studies with a total of 3244 participants to assess the effect of weight loss through dietary intervention on depressed mood. [11]
The authors of the study found that, in general, the majority of the studies showed that patients who achieved weight loss through calorie restricted diets experienced an improvement in their depression scores. Now, in my opinion, the effect sizes reported were a bit small. But when I consider the additional benefits of weight loss already discussed, plus the effect that achieving weight loss can have on other components of our health such as energy, strength, and focus, even a small effect size is worthy of praise here.
What I really found intriguing in my readings was what Fabricatore et al reported in their 2011 study published in the International Journal of Obesity. Their study reviewed 31 studies that altogether included 7937 patients. [12] And their research looked less at the level of impact that weight loss had and more at how the different approaches to weight loss impacted depression. They found that lifestyle modifications (defined as counseling on diet and exercise plus or minus behavioral interventions) were superior to treatment as usual or non-dieting protocols in reducing symptoms of depression.
Why I found this so interesting is because it speaks to what I have seen in my clinic. Something happens to people’s mood and mindset when they feel empowered to take control of their lives. People light up when they feel equipped to make real changes in their health via changes in their diet and the way they move. They start making other more intentional decisions and start to really feel as if they can live with a more optimistic attitude. Life stops happening to them and they start living!
Summary
So, with everything said and done, let's circle back to where we started. The journey of weight loss is not merely about shedding pounds; it's about reclaiming control over our health and well-being. Weight loss isn't a one-size-fits-all solution, nor is it solely about conforming to societal standards of beauty. It's about empowering ourselves to make choices that enhance our vitality and longevity.
Through the lens of managing diabetes, hypertension, and depression, we've uncovered the profound impact that shedding excess weight can have on our lives. From the potential for diabetes remission to the significant reduction in blood pressure and even the improvement in depressive symptoms, the benefits are undeniable.
As a primary care practitioner, I'm deeply invested in guiding my patients toward sustainable lifestyle changes that prioritize their health. Weight loss isn't just a goal; it's a tool for transformation, both physically and mentally. It's about embracing a journey of self-discovery and empowerment, where individuals reclaim agency over their bodies and lives.
So, whether you're embarking on your own weight loss journey or simply seeking understanding, remember this: it's not about the number on the scale, but rather the profound impact that reclaiming your health can have on every aspect of your life. Embrace the journey, celebrate the victories, and know that every step forward is a testament to your resilience and determination.
And one final note for those of you who live in the Fayetteville/Fort Liberty area. If you’re looking for a PCP who can help you lose weight safely, effectively, and focused primarily on lifestyle changes, I’m happy to help. Or even if you’re happy with your current PCP, but would appreciate having a coach, I also offer health coaching as its own service as well. Shoot me an email at golfran@truecaredpc.com or give me a call or send me a text at (910) 758-1769. Here's to a healthier, happier you!
References
1. American Diabetes Association. Statistics About Diabetes. Accessed on March 21, 2024 at https://diabetes.org/about-diabetes/statistics/about-diabetes
2. Center for Disease Control. What is Diabetes? Accessed on March, 21, 2024 at https://www.cdc.gov/diabetes/basics/diabetes.html
3. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551. doi:10.1016/S0140-6736(17)33102-1 PMID: 29221645
4. 59 th EASD Annual Meeting of the European Association for the Study of Diabetes . Diabetologia 66 (Suppl 1), 1–536 (2023). https://doi.org/10.1007/s00125-023-05969-6. Accessed at https://link.springer.com/article/10.1007/s00125-023-05969-6#Sec104
5. Jaeger BC, Chen L, Foti K, et al. Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data. Hypertension. 2023;80(6):1311-1320. doi:10.1161/HYPERTENSIONAHA.123.20900 PMID: 37082970
6. American Heart Association. Health Threats from High Blood Pressure. Accessed on March 21, 2024 at https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure
7. Yang S, Zhou Z, Miao H, Zhang Y. Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2023;25(5):404-415. doi:10.1111/jch.14661 PMID: 37141231
8. Khalil H, Zeltser R. Antihypertensive Medications. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554579
9. NIHM. Accessed on March 21, 2023 at https://www.nimh.nih.gov/health/statistics/major-depression
10. Frank RG, Huskamp HA, Pincus HA. Aligning incentives in the treatment of depression in primary care with evidence-based practice. Psychiatr Serv. 2003;54(5):682-687. doi:10.1176/appi.ps.54.5.682 PMID: 12719498
11. Patsalos O, Keeler J, Schmidt U, Penninx BWJH, Young AH, Himmerich H. Diet, Obesity, and Depression: A Systematic Review. J Pers Med. 2021;11(3):176. Published 2021 Mar 3. doi:10.3390/jpm11030176 PMID: 33802480
12. Fabricatore AN, Wadden TA, Higginbotham AJ, et al. Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. Int J Obes (Lond). 2011;35(11):1363-1376. doi:10.1038/ijo.2011.2 PMID: 21343903