What are the causes and treatments of weight gain?

From the Guidelines

Weight gain is primarily caused by consuming more calories than your body burns, and treatment should focus on a holistic approach combining dietary changes, regular exercise, behavioral modifications, and medical intervention when necessary. The causes of weight gain are multifactorial, including genetics, hormonal imbalances (such as hypothyroidism or polycystic ovary syndrome), certain medications (including antidepressants, steroids, and some diabetes medications), stress, poor sleep, and aging 1.

Key Factors Contributing to Weight Gain

• Genetics and hormonal imbalances
• Certain medications
• Stress and poor sleep quality
• Aging
• Consuming more calories than the body burns

Treatment Approaches

• Lifestyle modifications:
  • Balanced diet focusing on whole foods
  • Portion control and reduced intake of processed foods, sugar, and refined carbohydrates
  • Regular physical activity, with at least 150 minutes of moderate exercise weekly
• Medications:
  • Orlistat (120mg three times daily with meals)
  • GLP-1 receptor agonists such as Semaglutide (starting at lower doses and increasing gradually)
  • Phentermine (typically 15-37.5mg once daily)
• Bariatric surgery options:
  • Gastric bypass
  • Sleeve gastrectomy
• Addressing underlying medical conditions and managing stress through techniques like meditation or counseling

According to the most recent and highest quality study 1, a holistic approach to weight management is most effective, combining dietary changes, regular exercise, behavioral modifications, and medical intervention when necessary. This approach should be tailored to each patient's unique behaviors and comorbidities, considering medication interactions, contraindications, and risk of potential adverse effects. Weight-loss maintenance requires a long-term approach with chronic treatment and follow-up to prevent relapse.

From the FDA Drug Label

In female rats, an increase in early embryonic deaths occurred at 1 mg/kg/day. Reduced body weight gain and food consumption were observed in females at the 1 mg/kg/day dose. The causes of weight gain are not directly addressed in the provided drug labels. However, the labels do mention that reduced body weight gain was observed in female rats treated with liraglutide at a dose of 1 mg/kg/day, suggesting that the drug may have an effect on weight gain.

• The labels also mention that patients in the studies were instructed to follow a reduced-calorie diet and increase physical activity, which can help with weight management.
• Additionally, the labels state that treatment with SAXENDA resulted in a statistically significant reduction in weight compared to placebo, indicating that the drug can be effective in promoting weight loss. However, the labels do not provide information on the specific causes of weight gain. 2 2

From the Research

Causes of Weight Gain

• Modern lifestyle factors, such as a sedentary lifestyle and overconsumption of calorie-dense foods, can contribute to weight gain 3
• Refined carbohydrates can negatively impact metabolism and stimulate neural addiction mechanisms, leading to weight gain 3
• Behavior issues, including eating too quickly, lack of sleep, high stress levels, and lack of exercise, can also contribute to weight gain 3
• Specific dietary components, such as potato chips, potatoes, sugar-sweetened beverages, unprocessed red meats, and processed meats, are associated with weight gain, while vegetables, whole grains, fruits, nuts, and yogurt are inversely associated with weight gain 4
• Other lifestyle factors, including physical activity, alcohol use, smoking, sleep, and television watching, are also independently associated with weight change 4

Treatments for Weight Gain

• Education on wellness, prevention, and lifestyle changes can help address weight gain issues 3
• Pharmacotherapy, including medications such as orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide, can result in clinically significant weight losses and improvements in cardiometabolic risk factors 5, 6
• Certain medications, such as liraglutide, have been shown to have favorable effects on cardiovascular safety 5, 6
• A multi-disciplinary treatment approach, including pharmacotherapy, may be effective for patients with obesity and cardiovascular disease 6

Consequences of Weight Gain

• Weight gain is associated with an increased risk of medical illnesses, including type II diabetes mellitus, hypertension, and coronary heart disease 7
• Weight gain can also impair physical functioning, reduce quality of life, and is associated with poor mental health 7
• The risk of cardiovascular complications is a concern with current obesity drugs, and long-term safety data are needed to fully understand the effects of these medications 5