Clinical Application: Weight Management for Better Living

Learn about the latest advancements in the clinical application of weight management to support your healthy living journey.

Abstract

Obesity is a chronic, relapsing, and multifactorial disease with profound metabolic, psychosocial, and biomechanical consequences. In this educational post, I, Dr. Alex Jimenez, will guide you through the latest findings in obesity pharmacology from leading researchers. We will explore the complex neuroendocrine and environmental factors that contribute to obesity, the critical need to combat weight bias in healthcare, and the current evidence-based treatment strategies. I will detail the mechanisms, indications, and contraindications of various anti-obesity medications, from sympathomimetics to groundbreaking agents like GLP-1 receptor agonists. I will also present clinical case studies to illustrate how to individualize these treatments based on a patient’s unique health profile. A central theme of our integrative practice model at Injury Medical Clinic is the integration of advanced pharmacology, chiropractic care, functional medicine, and personalized lifestyle modifications. I will discuss how our collaborative practice, where I work alongside our Medical Director, Dr. Maria Guadalupe Cardenas, MD, leads to more sustainable and impactful health outcomes for our patients on their journey to better health.

Meet Our Integrative Care Team

Hello, I am Dr. Alex Jimenez. My credentials include DC (Doctor of Chiropractic), APRN (Advanced Practice Registered Nurse), FNP-BC (Family Nurse Practitioner-Board Certified), CFMP (Certified Functional Medicine Practitioner), IFMCP (Institute for Functional Medicine Certified Practitioner), ATN (Advanced Traditional Naturopath), and CCST (Chiropractic Certificate in Spinal Trauma). My life’s passion has been dedicated to understanding and treating chronic conditions, with a special focus on the complexities of obesity and its related complications.

At our practice, Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, we believe in a multidisciplinary, integrative approach to patient care. I am proud to work alongside Dr. Maria Guadalupe Cardenas, MD, who serves as our Medical Director and Collaborative Physician. Dr. Cardenas is Board Certified in Internal Medicine and brings over 40 years of invaluable experience as an internist to our team. Her NPI is #1164426749, and her Texas MD License is #J2933.

This collaborative model between a Doctor of Chiropractic (DC) and a Medical Doctor (MD) is a cornerstone of modern integrative and injury care. It allows us to safely and effectively blend my expertise in chiropractic care, rehabilitation, and functional medicine with Dr. Cardenas’s deep knowledge of internal medicine. Together, we provide a comprehensive suite of services that includes:

• Medical Oversight: Cardenas provides essential medical direction, ensuring that all treatments, including pharmacological interventions, are safe, appropriate, and managed in accordance with the highest medical standards.
• Chiropractic Care: We address the biomechanical consequences of obesity, such as osteoarthritis and back pain, through spinal adjustments, mobilization techniques, and rehabilitative exercises.
• Functional Medicine: We investigate the root causes of disease, considering genetics, environment, and lifestyle to develop personalized health strategies.
• Pharmacological Management: We use the latest evidence-based medications to treat conditions such as obesity, diabetes, and hypertension.
• Personal Injury Care: Our team is equipped to manage and rehabilitate injuries, which are often complicated by pre-existing conditions like obesity.
• Nutritional and Lifestyle Counseling: We guide patients toward sustainable changes in diet, physical activity, and behavior.

This integrated system ensures that our patients receive truly holistic care that addresses their health from every angle.

Understanding Obesity as a Chronic Disease

It’s essential to begin by framing obesity correctly. We now understand that obesity is a chronic, progressive, relapsing, and treatable disease. The idea that it’s a simple matter of willpower is outdated and harmful. When a patient stops their anti-obesity medication and the weight returns, it’s not a failure; it’s a relapse of a chronic condition, much like hypertension or high cholesterol would return if medication were stopped.

Obesity is profoundly multifactorial, involving a complex interplay of:

• Neurobehavioral Components: Habits, emotional eating, and psychological factors.
• Neuroendocrine Components: A sophisticated network of hormones that regulate appetite and metabolism.
• Metabolic Components: The way the body processes and stores energy.

An increase in abnormal body fat, or adipose tissue dysfunction, is a hallmark of the disease. This dysfunctional fat mass doesn’t just sit there; it actively promotes inflammation and contributes to a wide range of adverse health consequences, from metabolic issues like diabetes to biomechanical problems like osteoarthritis and incontinence. In the United States, the statistics are staggering: 41.9% of adults are classified as obese (BMI ≥ 30), and 9.2% have severe obesity (BMI ≥ 40).

The Social and Environmental Roots of Obesity

When we discuss the causes of obesity, we must look beyond the individual to the broader context. I often refer to these factors as the “social determinants of obesity”.

• Economic Stability: Decades ago, poverty was often associated with being underweight. Today, the opposite is often true. Calorie-dense, nutrient-poor foods are inexpensive and widely available, while access to high-quality, fresh food can be limited in impoverished areas.
• Education and Healthcare Access: A lack of nutrition education and limited access to quality healthcare create significant barriers to weight management.
• Neighborhood and Built Environment: If a person’s neighborhood is unsafe for walking or lacks green spaces, it severely limits opportunities for physical activity.
• Social and Community Context: Cultural perceptions of body weight and community norms can influence individual behaviors and health choices.

Beyond social factors, there’s a growing body of research on the environmental and genetic drivers of obesity. We’re identifying key hormonal players like ghrelin (the “hunger hormone”), leptin (the “satiety hormone”), and GLP-1 (a gut hormone that signals fullness). Furthermore, groundbreaking research into the gut microbiota is revealing how the balance of bacteria in our digestive system can influence weight and metabolism. Our modern, technology-driven, and often sedentary lifestyle only compounds these issues on a global scale.

The Critical Importance of Overcoming Weight Bias

For many years, the medical community debated whether obesity was a disease. Today, nearly every major medical organization, including the American Medical Association, recognizes it as such. This recognition is crucial, yet significant barriers remain: clinical inertia and weight bias.

Consider this shocking statistic: of the nearly 100 million people with obesity in the U.S., less than 1% receive a prescription for an anti-obesity medication, and less than 300,000 undergo bariatric surgery, despite 9.2% of the population having severe obesity. Why? The primary driver is weight bias.

Weight bias is the prejudice and discrimination directed at individuals because of their weight. It stems from the false belief that obesity is a simple failure of willpower. This bias is not just a social issue; it has deadly consequences. Research shows that the experience of weight bias increases complications and mortality independent of a person’s BMI. Our own biases prevent us from providing the care our patients deserve. In fact, studies from Harvard’s implicit bias project show that while biases against race, gender, and sexual orientation are decreasing, weight bias is the only form of bias that is increasing.

It is truly the last socially acceptable form of discrimination, and we, as healthcare providers, must confront it. Think about these provocative comparisons:

• We would never tell a patient with schizophrenia to “just stop hearing voices,” yet we often tell patients with obesity to “just eat less and move more.” Both involve complex neurochemical processes that cannot be willed away.
• We don’t require patients undergoing coronary artery bypass surgery to have a psychological screening. Yet, it has been standard practice for bariatric surgery patients, reinforcing the myth that obesity is purely a behavioral problem.

A Patient-Centered Approach to Obesity Care

So, how do we begin to change this? It starts with us, in our clinics. We must create a safe, non-judgmental space for our patients. I use frameworks like the””5 A’s” to guide these conversations:

• Ask: “Is it okay if we talk about your weight and how it might be affecting your health?”
• Assess: “Can you tell me about your weight history, what you’ve tried in the past, and what you understand about the effects of weight on health?”
• Advise: “Even a small weight loss of 3-5% can lead to significant health improvements. Let’s discuss some options.”
• Agree: “What are your goals? What feels achievable for you right now? Let’s work together to create a plan.”
• Assist and Arrange: “Would you like me to connect you with resources for behavioral therapy, exercise programs, or discuss medication options?”

For anyone with a BMI of 25 or more, especially with comorbidities like high blood pressure or pre-diabetes, we should be initiating conversations about lifestyle interventions. Our goal is a realistic 5-10% weight reduction over six months. This may not seem like a lot, but it can produce dramatic improvements in health markers.

Understanding Complex Eating Behaviors: Binge Eating Disorder

Before diving into treatments, it’s essential to understand some of the underlying behaviors that can contribute to obesity. One significant condition is Binge Eating Disorder (BED). From my clinical experience, particularly from my time working in bariatric surgery, a majority of patients described symptoms that align with this diagnosis.

BED is characterized by:

• Eating an amount of food in a discrete period that is definitively larger than what most people would consume in a similar timeframe.
• A profound sense of a lack of control over eating during the episode.

This is not a one-time occurrence but a pattern that occurs at least weekly for at least three months. It is also associated with marked distress and at least three of the following behaviors:

• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full.
• Consuming large amounts of food even when not physically hungry.
• Eating alone due to embarrassment over the quantity of food being eaten.
• Experiencing feelings of disgust, depression, or intense guilt after an episode.

It’s crucial to distinguish BED from other behaviors; it is not associated with the compensatory actions seen in bulimia, such as vomiting. Recognizing and diagnosing BED is a critical step, as it opens the door to targeted and effective treatments.

Pharmacotherapy: First, Do No Harm

Before we add medications to treat obesity, we must first review what our patients are already taking. Shockingly, patients with obesity are more likely to be prescribed obesogenic medications—drugs that cause weight gain. This can happen through appetite dysregulation or other physiological mechanisms we don’t fully understand.

Key classes of medications to watch for include:

• Antidepressants and Antipsychotics
• Mood Stabilizers and Anticonvulsants
• Antidiabetic Agents (e.g., sulfonylureas, insulin)
• Hormonal Contraceptives
• Corticosteroids

As an integrated team, we look at the whole person. If a patient with diabetes and obesity is on a sulfonylurea, which is known to cause weight gain, Dr. Cardenas and I might discuss switching them to a weight-neutral or weight-loss-promoting agent like a GLP-1 receptor agonist or an SGLT2 inhibitor. It’s about optimizing their entire medication regimen for better overall health, not just treating conditions in isolation.

An Overview of Anti-Obesity Medications

When lifestyle changes alone are not enough, pharmacotherapy can be a powerful tool. All approved weight-loss medications work better than placebo, which suggests they are worth trying. We generally categorize them into short-term and long-term options.

Short-Term Medications

These are primarily sympathomimetic agents that suppress appetite.

• Phentermine: This is the most commonly prescribed short-term medication and is relatively inexpensive. It is approved for use up to 12 weeks, but many providers continue it long-term if the patient is responding well without adverse effects. It requires diligent monitoring of blood pressure and heart rate due to a side effect profile that includes potential headaches, dry mouth, and tachycardia (increased heart rate), and it should be avoided in patients with cardiovascular disease.

Long-Term Medications

These medications are designed for chronic management of obesity.

• Orlistat (Xenical, Alli): A lipase inhibitor that blocks the absorption of about 30% of dietary fat. Available over the counter, it is relatively inexpensive and serves a dual purpose: it reduces calorie absorption. It acts as a behavioral disincentive to eating high-fat meals, since doing so can cause unpleasant gastrointestinal side effects.
• Phentermine/Topiramate (Qsymia): A combination drug approved for long-term use. Phentermine suppresses appetite, while topiramate, an antiepileptic drug, also contributes to appetite suppression and may lower leptin levels. While effective, it can be expensive and has a teratogenic component, meaning it can cause harm to a developing fetus and is contraindicated in pregnancy.
• Naltrexone/Bupropion (Contrave): This combination works on two different brain pathways. Bupropion, an antidepressant, stimulates the POMC system to reduce appetite and increase energy expenditure, while naltrexone blocks an inhibitory feedback loop, allowing bupropion to work more effectively and control cravings.
• Liraglutide (Saxenda): A daily injectable GLP-1 receptor agonist. Originally used for diabetes (as Victoza), this drug mimics a natural gut hormone that signals fullness to the brain, slows stomach emptying, and reduces appetite.
• Semaglutide (Wegovy): A weekly injectable GLP-1 receptor agonist, also used for diabetes (as Ozempic). It offers more significant weight loss than liraglutide and has become a cornerstone of modern obesity treatment. These GLP-1 agonists have been shown to produce profound and substantive weight loss that significantly impacts morbidity and mortality. Their primary drawback is high cost, though insurance coverage is improving.
• Tirzepatide (Zepbound): A weekly injectable that is a dual GIP and GLP-1 receptor agonist. Known as Mounjaro for diabetes, this medication acts on two different hormone pathways, leading to even greater appetite suppression and weight loss than GLP-1 agonists alone. It has demonstrated the highest efficacy to date in terms of total weight-loss percentage due to its powerful, synergistic effect.
• Lisdexamfetamine (Vyvanse): While not approved specifically for obesity, it is the only medication currently FDA-approved for binge eating disorder, a condition that is often underdiagnosed in patients with obesity. It works by impacting neurotransmitters involved in impulse control and focus. Addressing the underlying binge eating can be a critical step in managing weight.

Clinical Case Studies: Applying an Individualized Approach

Theory is important, but its application is what transforms patient lives. Let’s walk through a few clinical scenarios to see how we might tailor these pharmacological treatments.

Case 1: The Patient with Type 2 Diabetes and Hypertension

• Profile: A 45-year-old male with a history of hypertension, type 2 diabetes, and hyperlipidemia. Despite diligent efforts with diet and exercise, he has been unable to lose significant weight.
• Analysis and Strategy: My first principle is always “first, do no harm”. This patient is on glyburide, a sulfonylurea. This class of drugs increases insulin production, which is an obesogenic (obesity-promoting) mechanism. While it lowers his A1c, it actively works against his weight loss goals.

• Our strategy would be:
  1. Discontinue Obesogenic Medications: Consider stopping the glyburide and replacing it with a more beneficial agent.
  2. Optimize Existing Medications: We need to know his metformin dosage. I often see patients on a suboptimal dose, like 500 mg once or twice a day. The ideal dose for diabetes control and weight neutrality is typically 1,000 mg twice a day. We would aim to titrate his dose up, monitoring for any gastrointestinal side effects.
  3. Introduce a Synergistic Medication: For a patient like this, a GLP-1 or dual GLP-1/GIP agonist is a perfect fit. In this case, we prescribed semaglutide (Ozempic). Because he has a diagnosis of type 2 diabetes, his insurance is likely to cover Ozempic, making it a medically and financially sound choice. It will address his blood sugar, promote significant weight loss, and likely improve his blood pressure and lipid profile.

Case 2: The Patient with Pre-diabetes, Hypertension, and Depression

• Profile: A 38-year-old male with a BMI of 34, hypertension, pre-diabetes, and depression. His only medication is amlodipine for his blood pressure. He feels his weight gain is negatively impacting his mental health.
• Analysis and Strategy: This patient has multiple interconnected conditions. Our treatment choice should ideally address several of them simultaneously.

• Our potential strategies include:

1. 1. Confirm Diagnosis for Coverage: With a diagnosis of pre-diabetes, I would order both an A1c and a fasting blood glucose test. Sometimes, a patient meets the diagnostic criteria for diabetes on one test but not the other. Securing a diabetes diagnosis would open the door to insurance coverage for a GLP-1 agonist, which would be highly effective for his weight and pre-diabetes.
   2. Consider a Multi-Benefit Medication: An excellent option for this patient is naltrexone-bupropion (Contrave).

• • • The bupropion component is an effective antidepressant, which will directly address his depression. It also works to decrease appetite.
    • The naltrexone component modulates the brain’s reward system, helping reduce cravings and enhance bupropion’s effects.
    • The resulting weight loss would improve his pre-diabetes and likely his hypertension. This medication has a synergistic effect, targeting his weight, mood, and metabolic health all at once. We would start him on a low dose and titrate up over several weeks to manage side effects and optimize efficacy.

Case 3: The Patient with Binge Eating Disorder

• Profile: A 32-year-old female with a BMI of 31, mild hypertension, and anxiety. She has a formal diagnosis of Binge Eating Disorder (BED) from a mental health provider.
• Analysis and Strategy: For this patient, the primary driver of her weight gain is a specific neuropsychiatric condition. Therefore, the treatment must target the root cause.

• Our approach:
  1. Prescribe the FDA-Approved Treatment: The only medication currently FDA-approved for BED is lisdexamfetamine (Vyvanse). This medication works by impacting neurotransmitters involved in impulse control and focus. We would start at a dose of 30 mg daily and titrate up as needed.
  2. Monitor for Side Effects: A common concern is prescribing a stimulant like Vyvanse to a patient with anxiety. While it can sometimes increase physiological symptoms like heart rate, which may trigger anxiety, it can also have the opposite effect. For many with conditions like ADHD or BED, these medications improve focus and control, which in turn can reduce anxiety. Close monitoring is essential to ensure the benefits outweigh any potential side effects.

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Discovering the Benefits of Chiropractic Care- Video

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The Pillars of Effective and Ethical Prescribing

As we navigate the expanding landscape of obesity pharmacotherapy, several core principles must guide our practice.

1. Always Start with Lifestyle: Diet, physical activity, and behavioral modifications are the foundation for all patients. Pharmacology is an adjunct, not a replacement.
2. First, Do No Harm: Scrutinize a patient’s current medication list for any obesogenic drugs. If safe alternatives exist, make the switch. For example, replacing a sulfonylurea with a GLP-1 agonist in a patient with diabetes and obesity is a clear win.
3. Individualize Treatment: There is no one-size-fits-all solution. Consider the patient’s comorbidities, the required degree of weight loss, and medication costs. A patient with 300 pounds to lose will likely need a more potent agent like tirzepatide, whereas a patient with depression may benefit most from naltrexone-bupropion.
4. Set Realistic Goals and Monitor Continuously: This is a long-term process. Patients will not lose 100 pounds overnight. We must set realistic expectations based on clinical trial data. Frequent follow-ups are crucial for monitoring efficacy, managing side effects, and adjusting treatment. A good benchmark is looking for at least a 5% reduction in total body weight after three months to justify continuing a medication.
5. Engage in Shared Decision-Making: Have open conversations about treatment options, including the pros and cons of injectables versus oral medications and the realities of cost. Empowering patients to be active participants in their care enhances adherence and improves outcomes.

Integrating Chiropractic and Functional Medicine

Where does chiropractic care fit into this picture? Excess weight places enormous biomechanical stress on the body, leading to a host of musculoskeletal problems:

• Osteoarthritis, particularly in the knees and hips
• Chronic low back pain
• Sciatica and nerve compression
• Plantar fasciitis
• Poor posture and altered gait

As a chiropractor, I work to alleviate these symptoms through spinal adjustments, soft tissue therapies, and corrective exercises. This not only relieves pain but also improves mobility, making it easier for patients to engage in the physical activity that is so vital for weight loss and overall health.

From a functional medicine perspective, we dig deeper. We use advanced diagnostic testing to look for underlying imbalances—hormonal dysregulation, nutrient deficiencies, chronic inflammation, or gut dysbiosis—that may be contributing to weight gain. This allows us to create a truly personalized plan that may include targeted nutritional supplements, dietary modifications, and stress management techniques, all designed to restore metabolic balance from the inside out.

The Exciting Future of Obesity Treatment

The field of obesity medicine is advancing at an incredible pace. On the horizon, we have even more powerful tools being developed.

• Retatrutide (the “Triple G” ): This peptide injection targets GLP-1, GIP, and glucagon receptors. Early trials have shown a staggering 24% average weight loss over 48 weeks, with indications of less muscle loss than other agents.
• Oral GLP-1 Agonists: Oral versions of semaglutide and other new molecules like orforglipron are in late-stage trials, showing promising weight loss of around 15%. This would provide a fantastic alternative for patients who are averse to injections.
• CagriSema: This weekly injectable combines a GLP-1 agonist with pramlintide (an amylin analog), resulting in up to 20% weight loss over 68 weeks.

These developments, along with many others, promise a future where we can offer even more personalized and effective treatments. Our integrated approach ensures that we are not just prescribing a pill. We are partnering with our patients on a comprehensive journey, combining the best of modern medical pharmacology, evidence-based chiropractic care, and a root-cause functional medicine approach to help them achieve lasting health. Here at Injury Medical Clinic, we are committed to staying at the forefront of this research, integrating the best of chiropractic, functional, and allopathic medicine to guide you on your journey to wellness.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
2. Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes, Obesity and Metabolism, 19(9), 1242–1251.
3. Collins, L., & Costello, R. A. (2023). Glucagon-like Peptide-1 Receptor Agonists. In StatPearls. StatPearls Publishing.
4. [*Harvard University. (n.d.). Project Implicit. Retrieved June 22, 2026, from https://implicit.harvard.edu/implicit/*](https://implicit.harvard.edu/implicit/)
5. Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., … & SURMOUNT-1 Investigators. (2022). Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine, 387(3), 205-216.
6. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2018). Prescription Medications to Treat Overweight & Obesity.
7. The Endocrine Society. (n.d.). Obesity Playbook.
8. U.S. Department of Health and Human Services. (n.d.). Social Determinants of Health. Healthy People 2030. Retrieved June 22, 2026, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health*](https://health.gov/healthypeople/objectives-and-data/social-determinants-health)
9. S. Food & Drug Administration (FDA). (2021). FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014.

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