Danielle Kelvas Of The HCG Institute On What You Need To Know Before You Consider Taking Weight Loss Drugs

An Interview With Maria Angelova

Should you consider hiring a personal trainer, or some kind of accountability coach? Studies show that having accountability in any lifestyle change is critical to keeping the new behavior. Especially if you have relapsed in the past.

The pursuit of healthy weight management is a journey many of us embark on. In a world where quick fixes are often sought after, weight loss drugs have found a notable presence. However, like any medical intervention, there’s a need for understanding, caution, and professional guidance before considering such options. In this interview series, we are talking to doctors and medical and wellness professionals about the science, safety, efficacy, and ethical considerations surrounding weight loss drugs. As a part of this series, I had the distinct pleasure of interviewing Dr. Danielle Kelvas.

Dr. Danielle Kelvas, MD. She is a primary care physician with The HCG Institute, a telemedicine weight loss company, and the CEO & Founder of DKMD Consulting. Dr. Kelvas has been writing on the topic of weight loss and nutrition for over 10 years.

Thank you so much for joining us! Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’?

Thanks for having me. In my earlier years, I spent a considerable amount of time volunteering in third world countries, so I was exposed to the clinical prodromes of malnutrition and starvation. When I returned to the United States, and completed my medical studies, I was confronted with a brutal realization: while the U.S. may have an obesity problem, its population is still “starving.” The average American diet is fairly devoid of nutrition, mostly just artificial food and sugar, so people pack on the pounds, but they’re malnourished. Fat stigma is tough emotionally, and encourages eating disorders (disordered eating), and the vicious cycle ensues. It prodded me to be very intentional about what I eat and where my food comes from. I struggled for years as a kid with what I thought was IBS, but in reality I was eating entirely too much food that quite honestly left my body malnourished, but I was overweight.

Can you share with us the most interesting story from your career? Can you tell us what lessons or ‘takeaways’ you learned from that?

Some of the best advice I received in medical school is that every 5 years, everything I know will be wrong. While this sounds extreme, it’s been about 90% true. Since beginning my career in medicine, I’ve seen groundbreaking treatments in cancer, infectious disease, and surgical robotics emerge. We watched the world shut down during COVID like it was a movie, and now there’s cutting edge drugs to help you lose weight. So my takeaway? In medicine, never say never.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

1. Soft skills. The ability to negotiate and navigate a variety of personalities. In medicine, you work with people from all over the globe who are not going to think or communicate like you do, but you have to work together. My advice, read How to Win Friends and Influence People. (I remember I gifted this to a boyfriend many years ago, and he told everyone I got him a book on how to Win People and Keep Your Friends :) Still makes me laugh. You’ll get a lot farther in life if you learn how to handle tough conversations and negotiations. Give people the benefit of the doubt.
2. A loving community. I’ve had really bad days, and I mean bad, where I couldn’t even get out of bed. It’s going to happen. Invest in the people around you and they’ll invest in you, whether this be your family, friends, or even just a neighbor. Be there for people when they need you. You won’t get far on a team of 1.
3. Work hard. Competition is fierce, especially in business, and I never waited around hoping for money and things to fall out of the sky. I worked incredibly hard to get to where I am, and it’s brought me so much joy. I think apathy, depression, and sadness are pervasive right now, this learned helplessness, that keeps people from getting off the couch and chasing their dreams. I fail all the time, but every failure is a learning experience, so I fail forward. Don’t be afraid of failure. Be more afraid of never trying anything at all.

Ok, thank you for all that. Now let’s shift to the main focus of our interview. To begin, can you share with our readers a bit about why you are an authority in the fields of health, obesity, or weight loss? In your opinion, what is your unique contribution to the world of wellness?

Over the course of my career, I’ve lived and traveled to I think over 45 countries now, so I’ve seen the depths of starvation in third world countries and here in the United States. Obesity is just a different shade of being malnourished. I started my training in emergency medicine and later switched to primary care. A majority of the problems I treated in the outpatient setting stemmed from eating an artificial, processed diet: obesity, heart disease, gut dysbiosis, eating disorders, and the mental health consequences. While medication can certainly help to treat all of these maladies, improving the quality of our food, not just the quantity, is the silver bullet that no one’s talking about. It’s a serious, global problem.

Do you have any financial affiliations or conflicts of interest related to weight loss drugs that readers should be aware of?

DKMD Consulting, my medical writing and consulting firm, creates educational material surrounding many medical topics, including weight loss drugs, however my company and I do not have any direct financial incentives or kickbacks to prescribe or sell pharmaceutical medications. We’re passionate about combating disinformation online.

When should a person consider using weight loss drugs to lose weight?

You can consider medication to assist with weight loss, if:

1. Your BMI is above 30 (I genuinely dislike BMI for many reasons, because it isn’t an accurate metric, however it is a metric that is used in the medical community nonetheless so it must be listed here).
2. Being overweight has led to other diseases, like heart disease, high blood pressure, diabetes, etc. Continuing to be overweight will worsen most all chronic illnesses.
3. Someone has not been able to lose weight (~5% total body weight) with lifestyle changes alone over the last 6 months.

What are common examples of effective weight loss medications?

1. Orlistat

• Brand Name: Xenical (prescription), Alli (over-the-counter)

2. Phentermine

• Brand Name: Adipex-P, Pro-Fast, and Phentercot

3. Phentermine with Topiramate

• Brand Name: Qsymia

4. Lorcaserin

• Brand Name: Belviq (withdrawn from the market due to increased cancer risk)

5. Liraglutide

• Brand Name: Saxenda, Victoza

6. Naltrexone with Bupropion

• Brand Name: Contrave

7. Sibutramine

• Brand Name: Meridia (withdrawn from the market due to cardiovascular concerns)

8. Metformin

• Brand Name: Glucophage

9. Semaglutide

• Brand Name: Wegovy, Ozempic, Rybelsus

10. Tirzepatide

• Brand Name: Mounjaro

What are the potential side effects of weight loss with medication?

Metformin, Liraglutide, Semaglutide, Tirzepatide: The most common side effects are nausea, diarrhea, bloating, and some abdominal discomfort.

The stimulant medications like phentermine can cause anxiety, palpitations, and insomnia.

Of course, there are many other less likely side effects, but they just depend on the person.

How do weight loss drugs compare to other methods of weight loss in terms of effectiveness and safety?

Some guidelines state that if someone has a BMI of 40 or above, bariatric surgery is the best option. That being said, if someone struggles with an eating disorder, or has a heart problem, surgery isn’t an option. There is also a high risk of surgical complication and needing a surgical revision (one study showed the revision rate to be as high as 15% in 2018). This same study though, after crunching data on over 252,000 procedures, showed that surgery resulted in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions. Whether or not to go the surgical route needs to be discussed at length with your surgeon to balance the risk vs benefit ratio.

Are there certain populations or groups of individuals for whom weight loss drugs are particularly beneficial or harmful?

Weight loss medication can be beneficial for those who meet criteria for obesity and bariatric surgery isn’t an option.

People who struggle with disordered eating (an eating disorder), should discuss all of the risks vs benefits of weight loss medications with a trusted healthcare provider. While some of them can certainly be beneficial, the abuse risk is high. That being said, studies are underway, and it looks like semaglutide could be beneficial for binge eating disorder.

Some of the weight loss medications, like the GLP-1 agonists, can increase your risk of pancreatitis, gall bladder disease, and kidney disease, however these are rare.

There are some reports floating around that GLP-1 agonists can increase your risk of erectile dysfunction, depression, and suicidal ideation, but more research needs to be done. Correlation cannot imply causation. The FDA did release a cautionary note about potentially developing an intestinal blockage called ileus on GLP-1 agonists.

I really want to emphasize that while these drugs can be highly beneficial, it is so, so critical to take them while being monitored by a healthcare professional, and while still making a considerable effort to implement lifestyle changes. If someone promises you a magic pill that will make all of your problems go away, for a convenient price, and little to no medical follow up, run!

In your professional opinion, is it ok or not ok to take medications created for alternative health conditions (like diabetes) for weight loss?

Yes, this is perfectly fine. This is a very common practice, to use medication for off-label purposes. Obesity begets diabetes, and diabetes begets obesity. When you understand the pathophysiology of a drug, it’s perfectly reasonable to use them off-label. The FDA cleared semaglutide in 2021 for use in treating obesity not in the setting of diabetes, and it’s done remarkably well.

What are the potential side effects or dangers of taking medications aimed at alternative health conditions for weight loss? What are the benefits?

Providers have been using off-label (non FDA approved) drugs for weight loss for as long as I’ve been in practice. This means though that the common side effects haven’t been clearly defined in research studies in the literature, so it is up the healthcare provider to know the drug very well. It can be dangerous if the drug is brand new, because it hasn’t been out long enough to have a general sense of its common side effects when used at all, let alone off-label.

Based on your research or experience, can you please share your “5 considerations one should take into account before commencing weight loss through medicine?”?

1 . Is bariatric surgery a better option? Depending on how much weight you need to lose, 60lbs verses 200+ lbs, having a consultation with a bariatric surgeon should be considered. The literature shows that for a BMI above 40, surgery has better long term outcomes. I used to have a few patients every year travel to Mexico to get their stomach’s banded, because the procedure is cheaper there, but they didn’t have any surgical follow up back in the U.S. This is called medical tourism and very dangerous.

2 . Do you have an underlying eating disorder? If you struggle with bulimia or binge eating disorder, for example, weight loss medication may help, but it’s still important to seek treatment for the underlying mental health condition. Otherwise you may continue with poor cognitive thoughts and habits that led you to needing the medication in the beginning, creating a vicious cycle.

3 . Can you commit to taking the medication as prescribed, regularly, at the correct dose, and to following up with your healthcare provider? Missing doses or underdosing result in suboptimal weight loss. But skipping labs or follow up doctor appointments can be dangerous. I counsel patients to commit and trust the process. Surveillance labs are there for your protection.

4 . Are you committed to making critical lifestyle changes to keep the weight off? It feels great to lose weight, but it’s terribly hard on the body to cycle through periods of intense weight loss and gain. Weight loss medication is meant to be taken for a few months, ideally.

5 . Should you consider hiring a personal trainer, or some kind of accountability coach? Studies show that having accountability in any lifestyle change is critical to keeping the new behavior. Especially if you have relapsed in the past.

Are there any common myths or misconceptions about weight loss drugs that you’d like to address?

Weight loss medication isn’t a quick fix — it takes time. It can aid in weight loss, but ultimately lifestyle changes are what will keep the weight off.

Can you help articulate why it is important to upgrade one’s lifestyle in conjunction with medicated weight loss?

Being chronically overweight for years increases your risk of developing type 2 diabetes (among many other diseases). This is not just because of the weight, per say, but from fatiguing your digestive hormones. The pancreas secretes insulin to combat high amounts of sugar. Overtime, this fatigues the pancreas, so the body is not able to respond to insulin like it should (this is called insulin insensitivity). Medication can help you lose weight. But if someone continues to eat a high sugar, processed diet, the pathophysiology is still operating in the background that can still result in developing type 2 diabetes, heart disease, etc.

Beyond medication, what supplementary treatments or therapies do you recommend in conjunction with weight loss drugs for the best results?

I definitely recommend getting some kind of accountability in your life. You can hire a personal trainer, or join a program like Crossfit for example, where you can plug into a community.

Sometimes losing weight means changing your entire routine or friend group. For example, if your routine is usually to grab a happy hour drink with friends, a part of losing weight and keeping it off means trading the happy hour beverage for exercising with a different friend group after work. While this is just an example, it illustrates why sometimes people relapse or gain the weight back. Maybe this means putting the TV away for a few weeks or picking up a new sport. If the plan is just to take medication, and not change anything in your life, then you’re at a high risk for gaining back the weight.

If you want to change your life, then change your life. If you want something you’ve never had, then you have to do something you’ve never done.

How do you see the future of medicated weight loss evolving with advances in science and medicine?

In 2021, 12% of the United States population met criteria for diabetes.

1 in 3 adults are overweight.

More than 2 in 5 adults struggle from obesity.

About 1 in 11 adults struggle from severe obesity.

I believe we’ll see tremendous improvements in weight loss medication and surgery to meet these alarming statistics.

What is the best way for our readers to continue to follow your work online?

You can follow me on LinkedIn, The HCG Institute, and DKMD Consulting.

This was very inspiring. Thank you so much for the time you spent on this. We wish you only continued success.

About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.