Weight-loss medications are increasingly prescribed, yet experts warn that removing food as a coping mechanism may lead patients to transfer those behaviors to other habits. Dr Lara Courtenay, a general practitioner and bariatric physician at the MacMurray Centre in Auckland, warns that patients must address underlying psychological drivers to avoid replacing emotional eating with other compulsive behaviors.
Clinical Realities of Behavioral Substitution
Dr Courtenay notes that there is often a lot going on psychologically around food, and that when food is removed as a coping mechanism, other coping mechanisms can jump in. Patients who are stressed and want to eat might, for example, turn to online shopping instead. “You’ve got to make sure when you’re managing any form of addiction, that you’re not transferring that addiction,” she says. She adds that psychological support can help identify this transfer risk and “give you other things to do”.
For those on weight-loss medication, Courtenay says it’s important to understand medication is just one part of the equation. Before opting for weight-loss treatment, she says, a thorough review is the best place to start. “I see people every day, and they have underlying reasons for struggling with weight that they didn’t know. I see a lot of people that have deficiencies driving fatigue, which is making them not exercise and not lose weight.”
Nutritional Density and Metabolic Stress
Dr Courtenay emphasizes that because these medications reduce how much patients eat, what they eat needs to be nutritionally dense. “We don’t want undereating. So we don’t want really, really low calories.”
Physical activity recommendations also require nuance. Contrary to the belief that “hardcore” exercise is mandatory, Dr Courtenay says you don’t need to over-exercise as part of the weight-loss journey. “Everyone thinks you’ve got to go hardcore. You don’t have to. So 30 minutes of exercise a day, a walk is fine.” High-intensity exercise can make weight loss harder, as it can make the body a bit stressed, and then you sometimes want to eat more afterwards, like more calories. Stress is another factor that can make the weight-loss journey harder than it needs to be. “You’ve got to do something for yourself every day. Relax. Sleep’s really important. If you have broken sleep … your hunger hormones get messed up, and you’ll struggle with weight.” According to Courtenay, there are a lot of causes as to why people struggle with weight, so it makes little sense to address only one of them.
| Factor | Clinical Consideration |
|---|---|
| Behavioral Risk | Potential for addiction transfer to non-food habits |
| Nutritional Goal | Prioritize nutrient density over severe caloric deficit |
| Exercise Intensity | Moderate activity avoids systemic stress-induced hunger |
| Metabolic Support | Sleep hygiene is essential for hormonal regulation |
Require Comprehensive Medical Evaluation Before Initiation
Weight-loss medication is not a universal solution and requires a comprehensive medical evaluation before initiation.
