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Shedding Light on Weight Loss: A Nurse Practitioner's Guide to Evidence-Based Strategies and Medications

  • Writer: Hawley Campbell
    Hawley Campbell
  • Jun 4
  • 9 min read

Updated: Jun 11





As Nurse Practitioners (NPs), we're often the first point of contact for patients navigating the challenging journey of weight loss. Obesity isn't just a number on a scale; it's a complex, chronic disease with far-reaching health consequences. Our role goes beyond simply telling someone to "eat less and move more." It's about taking a holistic, evidence-based approach that weaves together lifestyle changes, behavioral support, and, when it's the right fit, medication.

This blog post will walk you through the many facets of weight loss management, highlighting key strategies and the role of medications—all from the perspective of an NP who's committed to truly patient-centered care.

Your NP: A Crucial Partner in Weight Loss

NPs are increasingly vital in the fight against the obesity epidemic. Our comprehensive approach, which often puts a strong emphasis on preventing illness, educating clients, and promoting overall health, makes us ideal partners for anyone looking to achieve sustainable weight loss. We have a unique opportunity to:

  • Start Conversations with Care: Bringing up the topic of weight needs to be done with sensitivity and empathy. We should focus on the facts—like BMI and related health risks—instead of using judgmental language. Always check in with your patient to see if they're comfortable discussing their weight, and frame weight management as a path to better health, not just a cosmetic goal. This really helps build trust and keeps clients engaged.

  • Dig Deep with Assessments: Beyond just a BMI, a thorough assessment means diving into your patient's dietary habits, how much they move, their sleep patterns, and their mental health. It's also critical to screen for related conditions like sleep apnea, fatty liver disease, heart issues, and hormone imbalances.

  • Craft Personalized Plans: There's absolutely no one-size-fits-all solution for weight loss. As NPs, we can work hand-in-hand with clients to set realistic, SMART goals (Specific, Measurable, Achievable, Relevant, Timely). This often involves:

  • Eating Smart: While there are countless diets out there, the focus should always be on sustainable, healthy eating patterns. This means teaching clients to limit ultra-processed foods, really understand food labels, practice portion control, and boost their intake of fruits, vegetables, and whole grains. Shared decision-making is key here – creating a dietary plan that genuinely fits their preferences and lifestyle.

  • Getting Active: A step-by-step approach to increasing physical activity usually works best. Start with short, manageable sessions and gradually build up. Don't forget to address any physical limitations and consider referring to specialists like physical therapists if needed.

  • Building Healthy Habits: Behavioral therapy is a cornerstone of effective weight management. This might include self-monitoring (like food diaries or activity logs), figuring out what triggers overeating, stress management techniques, and fostering accountability through regular check-ins or support groups.

  • Connecting the Dots to Resources: We can also help clients connect with outside resources such as registered dietitians, mental health professionals, and local exercise programs.

Medications: A Powerful Tool When Needed

For many clients, lifestyle changes alone just aren't enough to achieve and maintain significant weight loss. This is where pharmacotherapy becomes a valuable tool, used alongside comprehensive lifestyle interventions. As prescribers, NPs need to be well-versed in the available medications, understanding how they work, how effective they are, their potential side effects, and when they shouldn't be used.

The U.S. Food and Drug Administration (FDA) has given the green light to several medications for long-term weight management. These often lead to a 5-15% loss of original body weight and can really help manage hunger, cravings, and feelings of fullness.

Commonly Used Medications (as of mid-2025):

  • GLP-1 Receptor Agonists (e.g., Liraglutide [Saxenda], Semaglutide [Wegovy], Tirzepatide [Zepbound]): These medications mimic a natural hormone that helps regulate appetite, slows down how quickly your stomach empties, and makes you feel fuller.

  • How they work: They act on specific receptors in the brain to cut down on appetite and boost satiety. Tirzepatide even works on GIP receptors, giving it a dual punch.

  • How you take them: Usually once-weekly subcutaneous injections (Liraglutide is daily).

  • Common side effects: Nausea, vomiting, diarrhea, constipation. It's important to remember that dehydration can happen, so emphasize drinking plenty of fluids.

  • What to tell clients: Make sure they understand how to inject the medication properly, how to store it, potential side effects, and the importance of staying hydrated.

  • Phentermine/Topiramate ER (Qsymia): This is a combination pill that brings together an appetite suppressant with an anti-epileptic medication.

  • How it works: Phentermine curbs appetite, while topiramate might decrease appetite and boost fullness by modulating GABA receptors and inhibiting glutamate.

  • Common side effects: Dry mouth, constipation, tingling sensations (paresthesia), insomnia, dizziness.

  • Who shouldn't take it: People with glaucoma, hyperthyroidism, or those who've used MAOIs within the last 14 days.

  • Naltrexone/Bupropion SR (Contrave): This medication combines an opioid antagonist with an antidepressant.

  • How it works: It targets the brain's reward system to reduce cravings and appetite. Bupropion is thought to affect dopamine and norepinephrine, and naltrexone enhances this effect.

  • Common side effects: Nausea, constipation, headache, dizziness, insomnia.

  • Who shouldn't take it: People with uncontrolled high blood pressure, seizure disorders, eating disorders (like anorexia nervosa or bulimia), or those on chronic opioid therapy.

  • Orlistat (Xenical, Alli): This is a lipase inhibitor that works by reducing how much fat your body absorbs.

  • How it works: It blocks enzymes in your gut that break down fats, meaning less fat gets absorbed.

  • Common side effects: Oily spotting, gas with discharge, urgent bowel movements, and more frequent pooping. These are often much less severe if you stick to a lower-fat diet.

  • What to tell clients: Stress the importance of a low-fat diet to minimize side effects and the need for a daily multivitamin.

Important points when prescribing:

  • Who's a candidate? Generally, medication is considered for individuals with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition (like high blood pressure, high cholesterol, or type 2 diabetes).

  • Make it a Team Decision: Always have an in-depth conversation with your clients about the pros, cons, and other options for medication. Understand if they're truly ready for this step and what their preferences are.

  • Monitor Closely and Follow Up: Regular check-ins are crucial to see if the medication is working, if there are any side effects, and if the patient is taking it as prescribed. Adjusting doses as needed and offering ongoing support are vital for long-term success.

  • Tackle the Roadblocks: Be mindful of anything that might make it hard for clients to stick with their medication, like cost, side effects, or mistaken ideas about weight loss drugs.

Navigating Weight Loss for Clients with Mental Illness

Managing weight in clients who also struggle with mental illness comes with its own set of unique challenges and considerations. Many psychiatric conditions can directly impact weight, and quite a few psychotropic medications can significantly alter a patient's weight.

What Makes It Challenging:

  • Intertwined Conditions: Mental health issues like depression, anxiety, and binge eating disorder can often contribute to overeating or a lack of physical activity, leading to weight gain. Conversely, eating disorders can cause unhealthy weight loss or rapid fluctuations.

  • Medication-Induced Weight Gain: A big worry for both clients and providers is the weight gain that comes with certain psychiatric medications. This can unfortunately lead to clients stopping their meds, which can worsen their mental health and increase their risk of metabolic syndrome and heart problems.

  • Antipsychotics: Especially the newer, second-generation (atypical) antipsychotics like olanzapine (Zyprexa) and clozapine (Clozaril) are well-known for causing substantial weight gain. Others like quetiapine (Seroquel) and risperidone (Risperdal) also carry a risk. Some, like ziprasidone (Geodon), aripiprazole (Abilify), and lurasidone (Latuda), are considered more weight-neutral options.

  • Mood Stabilizers: Lithium and valproate (Depakote) are commonly linked to weight gain.

  • Antidepressants: While many antidepressants are weight-neutral or can even cause initial weight loss, some, such as mirtazapine (Remeron) and paroxetine (Paxil), are more likely to lead to weight gain.

  • Impact on Sticking with Treatment: Gaining weight can be really distressing for clients, potentially causing them to stop taking vital psychiatric medications. This, in turn, can put them at risk for a relapse of their mental health condition.

Weight Loss Medications for clients with Mental Illness:

When we're helping clients with mental illness manage their weight, NPs must be incredibly careful about potential drug interactions, whether a medication might worsen psychiatric symptoms, and how it fits into their overall treatment plan.

  • GLP-1 Receptor Agonists: These medications (Liraglutide, Semaglutide, Tirzepatide) are often a strong choice because they're effective for weight loss and generally have a good safety profile. Some research even suggests they might have positive effects on mood and could be especially helpful for clients taking antipsychotics known to cause weight gain. Liraglutide, in particular, has been quite thoroughly studied in psychiatric populations.

  • Metformin: Though primarily a diabetes medication, metformin is frequently used "off-label" to manage weight gain and metabolic side effects caused by antipsychotics. It works by improving insulin sensitivity and can reduce appetite. Some guidelines even consider it a first-line option for this purpose.

  • Bupropion: As mentioned earlier, bupropion is part of the naltrexone/bupropion combination. Bupropion alone (Wellbutrin) is an antidepressant that often leads to weight loss or is weight-neutral. This makes it a great choice for clients with depression who are also worried about their weight, or as an alternative to antidepressants that tend to cause weight gain.

  • Topiramate: This medication, which is used with phentermine for weight loss, can also be prescribed on its own for weight loss. It's an anticonvulsant that can cause weight loss and might be an option for clients who also have seizure disorders or certain types of migraines. However, it's worth noting that some clients experience cognitive side effects (sometimes called "topiramate fog"), which can be a concern, especially if they already have some cognitive impairment.

Important for NPs:

  • Thoughtful Medication Choices: When starting or adjusting psychiatric medications, NPs should try to choose options that are less likely to cause weight gain, if it makes sense clinically for the patient.

  • Consistent Monitoring: Closely monitoring weight, metabolic markers (like blood sugar and cholesterol), and mental health status is vital for all clients, particularly those on psychiatric medications.

  • Collaborative Care: Working closely with psychiatrists, mental health therapists, and registered dietitians is essential to provide truly comprehensive, integrated care that looks after both mental and physical health needs.

  • Patient Empowerment: Giving clients the knowledge they need about their medications, potential side effects, and strategies for managing their weight is absolutely paramount.

Psychotropic Medications That Can Actually Cause Weight Loss

While many psychiatric medications unfortunately lead to weight gain, a few can actually result in weight loss or are considered weight-neutral. Knowing these can help NPs make more informed decisions, especially when a patient is concerned about their weight.

  • Stimulants (e.g., Methylphenidate, Amphetamines): Commonly used for Attention-Deficit/Hyperactivity Disorder (ADHD), stimulants often lead to a decreased appetite and weight loss. This effect is usually most noticeable when someone first starts taking them.

  • How they work: They primarily increase dopamine and norepinephrine levels, which can suppress appetite and boost metabolism.

  • Bupropion (Wellbutrin): As a norepinephrine-dopamine reuptake inhibitor (NDRI), bupropion is less likely to cause weight gain than other antidepressants and can even help with weight loss.

  • How it works: It's believed to influence neurotransmitters involved in appetite regulation and how the body uses energy.

  • Fluoxetine (Prozac): An SSRI (selective serotonin reuptake inhibitor), fluoxetine can sometimes cause initial weight loss because it can suppress appetite, though weight might stabilize or even increase over longer periods.

  • Duloxetine (Cymbalta): An SNRI (serotonin-norepinephrine reuptake inhibitor), duloxetine may also lead to some initial weight loss.

  • Topiramate (Topamax): While primarily an anticonvulsant, its use can indeed result in weight loss, as we discussed earlier.

Staying Current: Evolving Guidelines and Future Directions

The field of weight loss management is constantly changing. As NPs, we need to stay up-to-date with the latest clinical guidelines from organizations like the American Association of Nurse Practitioners (AANP), the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS). New medications and combination therapies are always emerging, offering even more options for our clients, including those with complex health challenges like mental illness.

Our role as NPs in weight loss management is incredibly diverse and impactful. By combining evidence-based lifestyle changes with appropriate medications, considering the unique needs of clients with mental illness, and fostering a supportive and empathetic environment, we can truly empower our clients to achieve meaningful and lasting weight loss. This ultimately leads to a significant improvement in their overall health and quality of life.

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