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Weight management can be challenging. From figuring out how to adjust your diet to choosing the best exercise routine to implement, there are a few decisions to be made prior to kickstarting your weight loss journey. Aware of these hurdles, Haute MD asked Haute MD expert Dr. Mike Hoaglin about his weight loss program and the tactic that he uses to optimize his patient’s results.

Haute Beauty: How do you help people begin their weight loss journey?

Dr. Mike Hoaglin: For weight loss to be meaningful and lasting, there needs to be a change in mindset. A diet is simply not enough. It’s all about changing our relationship with food and our initial response to the sensation of hunger.

The first thing I ask patients to examine is their relationship with white flour. White flour (over) consumption is a big reason many people gain weight. The problem is that white flour not only tastes good, but it also makes us feel good–initially. Unfortunately, it does a number of things to our body and metabolism that are not healthy in the long run.

HB: Why is it important to evaluate your metabolism and lifestyle?

MH: We need to take a close look at where the hidden issues are, and that means measuring things beyond the numbers on the bathroom scale. Your metabolism is governed by a number of variables — some things we can’t control like your genes but other things we can influence such as sleep quality, activity levels, and food choices. If you’re not sleeping, it’s a non-starter when it comes to weight loss. If your gut microbiome is imbalanced or your stress levels are poorly controlled, healthy weight loss will be extraordinarily difficult.

I like to help my patients develop a better “cockpit” to know how they are doing healthwise while on their weight loss journey. With attention to the right numbers, they’ll know they’re headed in the right direction and the bathroom scale may actually become less useful over time. We might look at glycemic response with a continuous glucose monitor or stress issues with a heart rate variability monitor, for example.

HB: You offer a range of services, which one have you seen the most success with?

MH: While we do offer cutting-edge services, we see incredible success with simply optimizing food choices through elimination or ketogenic diets. The people who are most successful are the ones whose mindset changes and evolves along the way. Kicking off lifestyle changes with a fasting-mimicking diet or another reset strategy can add momentum to that shift in mindset in the right person.

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HB: What pharmaceuticals do you offer for weight loss?

MH: It’s important to take a look at what factors might make weight loss a challenge for an individual. Is there a satiety or appetite problem? Are there signs of food addiction or poorly controlled cravings? There are a number of medications available (some with FDA-approved weight loss indications) to support the journey where appropriate, such as the combination of bupropion and naltrexone. If there is underlying type II diabetes or signs of insulin resistance, the newer GLP-1/GIP agonists like semaglutide or tirzepatide may be appropriate.

Metformin is typically thought of as an old drug for type II diabetes, but we’re often seeing it used off-label for weight loss. The medical literature suggests that some components of metformin’s positive metabolic effects take place in the gut microbiome.  If a gut health issue is suspected, specific probiotic supplements may be part of the plan as well.  But as with any intervention, pharmaceuticals, and supplements come with certain risks, so those need to be addressed and discussed.

HB: What does a basic weight loss plan usually look like?

MH: A basic plan gives patients the knowledge to choose and prepare foods wisely. They will have an idea of what activities will be high-yield for metabolic benefit. Patients will also know how to use the tools and sensors needed to help measure and understand their own bodies. They will also be in touch with us throughout the journey so that we may continuously refine the plan based on each phase of their response. Some patients have underlying medical or mental health issues that need to be adequately controlled first before meaningful and sustainable weight loss can be achieved.

HB: How long do you go on the weight loss journey with your patient for?

MH: We are available for as long as the patient needs Gut Feelings Psychiatry and a healthy number of patients remain with us for years on maintenance. Others just need us for a few months of reset, education, and inspiration to be off to the races on their own.