The question might be asked, can’t I just practice discipline, hard work and expect to see the goals I set? The answer is… maybe. This is where we really need to take an individualized approach at treatment and planning as no “one size fits all”. The intent of this review will be to briefly describe how safely utilizing medications in the appropriate patient can help us achieve better outcomes. Let’s jump into a case study.

AT is a 49-year-old female who works full-time as a real estate broker and would describe her work as “very stressful”.  She has always struggled with weight and has been somewhat active over the years trying to maintain her health. She has had gym memberships and finds she will go 1-2 times a week. She walks on the treadmill, does a bit of resistance training, however, generally sees the gym as boring and hasn’t made any real progress, plus her lower back is becoming increasingly sore. She is feeling herself slow down and is really concerned as her weight is now beginning to climb. She is sleeping poorly at night, wakes up feeling unrested and pushes into the workday with an extra dose of caffeine. She is happily married, however, wishes her intimacy could be better yet generally lacks interest. She knows she needs to exercise, would love to start shedding some pounds and would like to get back into hiking with her friends, however, is just so tired. She is in a brain fog, feels sore after her day of exercise and would rather watch TV after a busy day at work than to get out and move. She knows that unless she makes some changes now, her health will rapidly start to decline over the next decade.

AT comes to the clinic a little skeptical that she can improve as she has been on several “yo-yo” diets in the past. She is afraid that after a few weeks, she will be too sore to return. At the initial consultation, we review her symptoms and obtain some baseline lab work discovering that AT is in a peri-menopausal state. This is likely contributing to many of her complaints of low energy, brain fog, poor sleep and loss of libido. We decide to start supplementation with Estrogen and Progesterone, helping to restore her hormones to a premenopausal state. We recognize the stressors of work and decide to start AT on Bupropion. Bupropion will help to improve her sense of “well-being” and alleviate work related stress issues. A common side-effect of Bupropion is loss of appetite – great if we are interested in loosing weight. Unfortunately, this side-effect only lasts the first few weeks of treatment, however if we combine it with Naltrexone, this effect will last indefinitely.

At the initial consultation, we obtain body composition analysis showing 37% body fat, we obtain static and dynamic movement assessments and a cardiovascular evaluation. This reveals a common body imbalance known as “Lower-Crossed” syndrome, likely from the many hours she spends sitting at a computer. We evaluate her goals which include weight loss, improved energy and improved strength. She would really like to enjoy hiking again and not suffer from ongoing back pain.

Prescriptions are sent off and a personalized training program is developed based on linear progression as we work toward those goals. Her daily caloric intake needed to safely lose weight is calculated and a nutritional plan with recipes / shopping list based on her food preferences is developed. AT starts by walking on a treadmill 3 days a week coupled with core stability exercises and stretching, thus helping to overcome her tight hip flexors and weak abdominals contributing to her muscle imbalance and poor posture. AT completes her first week of training surprised that she feels pretty good. She is not sore and is already starting to feel a little more “alive”. By the completion of her second week, she has already started to develop a bit more self-confidence simply as she has been able to stick to her training schedule for 2 full weeks. At the completion of her first month, she has lost 4 lbs however more importantly, her entire mental outlook has started to change. She is less stressed, sleeps better at night and feels like she has more energy. She is excited to start phase 2 of training and see what changes she can bring to her body.

Do we need medications? Not necessarily, however in AT’s case, medications really aided in her transition to a healthier state. Without these, AT would have continued to battle fatigue and mental drain. The challenge of starting a new fitness routine in the setting of such profound fatigue may have been a barrier she was unable to overcome.

As we are looking at reaching our fitness goals and transforming our lives into a healthier and more fit state, barriers to progress are a real concern. Many of these barriers can be addressed by utilizing tools at our disposal. Hormone replacement such as Testosterone, Estrogen and Progesterone can help improve energy, decrease body fat and improve general wellbeing. Sympathomimetics such as Phentermine and Vyvanse can help curtail appetite. Suppose we struggle with carbohydrate or fat cravings, medications such as Acarbose and Orlistat can help block the breakdown of these nutrients in the gut thus decreasing their absorption. Intranasal Oxytocin can help alleviate some of the cravings for “pleasure foods”. GLP-1’s such as Tirzepatide and Semaglutide can decrease hunger and help us feel full longer.  These medications and many more, were never intended to be utilized on a long-term basis strictly for improving weight and fitness. Unfortunately, we see that happening more and more frequently. The intent should be to use these medications for a short period of time while every effort is made at transitioning to a healthier lifestyle of fitness, nutrition and health. Ultimately, our bodies are designed to move and be fueled with clean nutritious foods. The problem, however, is transitioning our bodies to that state in a world of stress, high demands and years of poor lifestyle choices. Combine that with the natural consequences of aging and sometimes the barriers to change are just too great.

So, to answer the question first proposed; can’t I just practice discipline, hard work and expect to see the goals I set? Yes, you can… however if find you continue to struggle to reach those goals, modern medicine has provided tools to assist you along that journey.