Medical weight management

If you have tried to lose weight again and again, you are not alone, and it is not a failure of willpower. Body weight is shaped by genes, hormones, the gut, sleep, stress, medicines and the world we live in. Dr. Michael Pimienta is triple board-certified, in gastroenterology, obesity medicine and internal medicine, and offers medical weight management to adults across Los Angeles County. His approach starts with listening.

Is obesity a medical condition?

Yes. Medical groups such as the Obesity Medicine Association describe obesity as a chronic, relapsing disease, much like high blood pressure or diabetes. That matters for two reasons. First, it means your body actively defends its weight: when you eat less, hunger often rises and your body burns less energy, which is why weight so often comes back after a diet. Second, it means obesity deserves real medical care, without blame or shame.

Doctors often use body mass index (BMI), a number based on height and weight, as a starting point. A BMI of 30 or higher is in the obesity range. But BMI is only one number. Dr. Pimienta also looks at where your body carries weight, your blood pressure, blood sugar, cholesterol and liver health, and how weight affects your daily life, your joints, your sleep and your mood.

The goal is better health, not a number on a scale. Losing 5 to 10 percent of your starting weight can lower blood sugar, blood pressure and triglycerides (a type of fat in the blood) for many people.

Why see a GI doctor for weight?

Your digestive system and your weight are closely linked. Many conditions a gastroenterologist treats are tied to excess weight, and a GI doctor understands the gut hormones that help control hunger and fullness.

• Fatty liver disease: fat building up in the liver, now called MASLD, is common in people with obesity and can lead to scarring over time. Weight loss is the main treatment. See fatty liver disease.
• Acid reflux and heartburn: extra weight around the belly can push stomach acid up into the esophagus. Many people find their reflux improves as they lose weight. See acid reflux and GERD.
• Gallbladder: obesity raises the chance of gallstones, and so does losing weight very quickly. A gradual plan helps.
• The gut and appetite: the gut sends signals to the brain about hunger and fullness. Newer weight-management medicines work by copying some of these gut hormones, and their most common side effects are digestive.

Because Dr. Pimienta is also a gastroenterologist, he can care for your weight and your digestive or liver health in the same place.

What happens at a weight-management visit?

Your first visit is a conversation, in person at the Wilshire office or by secure video if you are in California. It usually covers:

• Your history: how your weight has changed over the years, what you have tried, and what worked or did not
• Your goals: what you want to improve, such as energy, blood sugar, liver health, mobility or how you feel
• Labs as needed: such as blood sugar, cholesterol, liver and thyroid tests, to look for related conditions
• Nutrition: practical changes that fit your culture, budget and schedule, not a one-size-fits-all diet
• Activity: movement you can enjoy and keep up, at your own starting point
• Sleep and stress: poor sleep, sleep apnea and stress all affect hunger and weight
• A medicines review: some common medicines can cause weight gain, and sometimes there is an alternative

Together, you and Dr. Pimienta decide on a plan. For some people, that means nutrition and lifestyle changes alone. For others, it includes medicine. Your plan depends on your health; Dr. Pimienta will talk with you about what fits you.

What medicines are used for weight management?

Medicines do not replace healthy eating and activity, but they can make those changes work better, mostly by reducing hunger and helping you feel full sooner. The newest group of medicines copies gut hormones:

• GLP-1 medicines, such as semaglutide (Wegovy for weight management; Ozempic for type 2 diabetes)
• GIP/GLP-1 medicines, such as tirzepatide (Zepbound for weight management; Mounjaro for type 2 diabetes)

These are usually weekly injections that start at a low dose and increase slowly over several months. Older medicines taken by mouth are also available and may fit some people better. Dr. Pimienta will talk with you about each option, including the benefits, side effects and cost.

Who may qualify?

Under national guidelines, a doctor may prescribe a weight-management medicine for an adult with:

• A BMI of 30 or higher, or
• A BMI of 27 or higher along with a weight-related health problem, such as high blood pressure or type 2 diabetes

Some people should not take certain medicines. For example, GLP-1 and GIP/GLP-1 medicines are not used during pregnancy, or in people with a personal or family history of medullary thyroid cancer or a condition called MEN 2. Dr. Pimienta reviews your health history first.

What results can I expect?

Results vary by medicine and by person, and no one can promise a specific result. In clinical trials, people taking these newer medicines along with lifestyle changes lost more weight on average than people taking a placebo, and with some medicines more than half of participants lost 10 percent or more of their starting weight. Many people regain weight after stopping, so these medicines are often used long term, like medicines for blood pressure.

What are the side effects, and how are they managed?

The most common side effects are digestive, which is one place a gastroenterologist can help. They include:

• Nausea, especially in the first weeks and after a dose increase
• Vomiting, diarrhea or constipation
• Heartburn, burping and bloating
• Feeling full quickly

These often ease with time. Things that usually help include increasing the dose slowly, eating smaller meals, stopping when you feel full, limiting greasy and very sweet foods, and drinking enough fluids. Dr. Pimienta can adjust the dose or the plan if side effects get in the way. Read more in our article GLP-1 medicines and your digestion.

What about weight-loss surgery?

Dr. Pimienta does not perform weight-loss (bariatric) surgery or weight-loss procedures. For some people, especially those with a higher BMI and serious weight-related conditions, surgery can be a very effective option. He can talk with you about all of your options, including a referral to a surgeon when surgery may help, and he can continue to care for your digestive and liver health before and after.

How often are follow-up visits, and what does it cost?

Weight management is ongoing care. Follow-up visits are usually more frequent at the start and while a medicine dose is being adjusted, then spaced out as things settle. Many follow-ups can be done by video if you are in California at the time of the visit.

Dr. Pimienta accepts Medicare, including patients with a secondary (supplemental) plan. For other insurance, the practice is out of network and visits are self-pay; our team explains pricing before anything is booked, and a superbill is available so you can seek out-of-network reimbursement. Coverage for weight-loss medicines varies by plan; we review options and costs with you. See insurance and payment.

Questions patients ask

References

1. Obesity Medicine Association. What Is Obesity?
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Prescription Medications to Treat Overweight and Obesity.
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Adult Overweight and Obesity.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Bariatric Surgery.