Medical Management of Weight Loss

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In this episode of Healthful Woman, Board-certified obesity medicine specialist and brother of Dr. Nathan Fox joins us to discuss weight management and treatment of obesity. Dr. David Fox helps people in his general practice understand the medical implications of obesity and works to destigmatize the societal shame surrounding what, at the end of the day, is a problem that can and should be treated as any other medical risk factor.

Many weight loss patients first try to lose weight on their own through diets, things they have read on the internet, guided programs such as Weight Watchers, etc. However, they often find that they cannot be successful on their own and then seek the help of a doctor. This is where Dr. David Fox comes in.

Dr. David Fox, brother of Dr. Nathan Fox, has been in practice for about a decade now. He is a primary care doctor who practices obesity medicine. In other words, other medical providers refer patients to him to help them lose weight through a combination of lifestyle advice, prescription of medications, and weight loss surgeries. While Dr. David Fox does not perform weight loss surgery, he does follow these patients before and afterward to help with medical management.

The Complex Societal Topic of Obesity

Weight is a sensitive topic, and physicians aim to approach it in a respectful manner due to social stigmas attached to obesity. Obesity is a very complex disease, and many factors can contribute to it. However, Dr. David Fox does believe that we do have some control when it comes to weight loss, as he has seen it achieved through lifestyle changes, medications, and surgeries. “ I think the main point is when we’re talking to patients with obesity, we should not blame them, we should not imply that it’s entirely their fault and if they would just make the changes they need to make, they can lose the weight.” He explained.

Adding to the sensitive topic of weight and obesity in society is the idea that people should respect and love all body types. On the other hand, medical professionals also understand that medically, certain body types may be at higher risk for health issues. This is a tightrope that medical professionals must balance.

In cases where a patient has a definition of obesity based on their height, weight, and body mass index, but otherwise does not have complications such as hypertension, or diabetes, Dr. David Fox still takes an approach of assessing their overall health, which may include checking for secondary signs of obesity such as thyroid disease or endocrine disease. Ultimately, it depends on the individual patient. He will also discuss with the patient their weight loss goals, if any, to create an individualized treatment plan.

Dr. David Fox’s Weight Loss Approach

To help patients who do wish to lose weight, Dr. David Fox takes an individualized approach. However, there are some tried and true beliefs that he leans on. “I’m not a big believer in aggressive diet changes or aggressive exercise,” he explained. “These are changes that I want them to be able to sustain for their entire lives. I’m not going to put them on some extremely low-calorie diet they can only do for a few months to lose a lot of weight and then gradually taper off of that. I tend to counsel on a slow and sustained weight loss. I’m trying to get them to lose maybe one to two pounds a week.”  His overall treatment plan usually consists of counseling, diet, exercise, changes that they could sustain over time, and sometimes, the help of a dietician.  

One of the most successful slow and steady weight-loss diets Dr. David Fox recommends is the Mediterranean diet. “That one probably has the most evidence behind it in terms of not just maintaining a healthy weight, but just maintaining general health,” he explained. “It’s been studied with heart health and brain health. Eating a lot of plant-based foods, trying to avoid added sugar and refined carbohydrates…trying to limit red meat intake. You can focus more on fish and poultry, which are a little bit healthier, and eating healthier fats.” There are also other reasonable diets such as variations of the low-carb diet, and intermittent fasting which can help people lose weight in a healthy manner.

Dr. David Fox also speaks to his weight loss patients about the importance of exercise. Many of the patients that he sees may not exercise at all, so he gives them a goal of 150 minutes per week of moderate to higher-intensity exercise. “Now, if it’s less great, I’ll take anything,” he said. “If you’ve got 20 minutes a week, that’s fine. But I try to set a goal of 150 minutes a week, which most patients if they really take a close look at their schedule, they’re able to fit in.” This can be done at home or in the gym; whichever is the most comfortable for the patient.

Weight Loss Medication Options

While weight loss medication has been around for a while, over the last decade, many new weight loss medications have come onto the market. Those available in pill form offer a 5-10% amount of weight loss and require a long-term commitment.

Over the past five years or so, a new group of medications has come out called GLP-1 receptor agonists. Used to treat diabetes, these medications have incredible effects on satiety and help people lose weight. There are also now some drugs in that class available just for the purposes of obesity. “One recent study shows that one of these drugs helped you lose about 20% of your weight, which is amazing,” explained Dr. David Fox. “That’s almost surgical numbers.”

Weight Loss Surgery

Dr. David Fox is a supporter of weight loss surgeries for the right candidates, as they are very effective and generally safe. The two most popular weight loss surgeries include gastric sleeve and gastric bypass. “The sleeve is you remove just the majority of the stomach,” he explained. “And then the bypass you remove the majority of the stomach plus you remove some of the small intestine from the circulation. Both of them are done laparoscopically, which means that they make fewer incisions.” Overall weight loss surgeries are a great tool for those who qualify and who have failed to lose weight with other conservative measures.


Overall, obesity is a complex disease that can be caused by a variety of factors. Dr. David Fox says that if you are overwhelmed with the prospect of losing weight, the first step is to get started. “They just need to get started,” he explained. “And then yes, I agree with that snowball effect. So, I’m just trying to get something going.”

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