Clinical Application: Weight Management for Success

Find out how weight management techniques in a clinical application can support your journey towards a healthier weight.

Abstract: A Modern, Integrative Approach to Obesity Management

Obesity is a chronic, relapsing, and multifactorial disease that affects a staggering number of individuals worldwide. This educational post delves into the complexities of obesity, moving beyond outdated notions of willpower to explore its deep-seated neurobehavioral, metabolic, and genetic roots. We will examine the latest findings on the pharmacology of weight management, exploring how modern, evidence-based medications such as GLP-1 receptor agonists, GIP/GLP-1 therapies, naltrexone-bupropion, and others can serve as powerful tools in a comprehensive treatment plan. This discussion will highlight the critical need to combat weight bias in healthcare, which significantly hinders patient outcomes. Furthermore, we will explore how an integrative care model that combines advanced chiropractic techniques with internal medicine, functional medicine, and personalized rehabilitation provides a holistic and effective pathway for patients on their journey toward sustainable health. At our clinic, this collaborative approach is championed by Mr. Maria Guadalupe Cardenas, MD, and me, ensuring our patients receive comprehensive, multidisciplinary care.

Our Collaborative and Integrative Care Model in El Paso

At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic, in El Paso, Texas, we have cultivated a unique and powerful multidisciplinary environment designed to address complex health issues, such as obesity, from multiple angles. I am Dr. Alex Jimenez, and my expertise in chiropractic care, functional medicine, and Family Nurse Practitioner practice is complemented by the invaluable medical oversight of Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is Board Certified in Internal Medicine and serves as our Medical Director and Collaborative Physician. With over 40 years of experience as an internist (NPI #1164426749, Texas MD License #J2933), she provides the essential medical framework for our integrative protocols.

This collaborative setup allows us to blend different disciplines for a truly holistic patient experience seamlessly:

• Medical Oversight (Dr. Cardenas): Dr. Cardenas provides crucial medical direction, overseeing diagnoses and medication management, and ensuring that all treatments align with established medical safety and efficacy standards. Her role is vital, especially when considering pharmacotherapy for obesity and its related comorbidities such as hypertension, type 2 diabetes, and cardiovascular risk.
• Chiropractic and Functional Medicine (Dr. Jimenez): My role involves focusing on the biomechanical and functional aspects of health. Through advanced chiropractic adjustments, we address musculoskeletal issues such as osteoarthritis, which is often exacerbated by excess weight. Using a functional medicine lens, we investigate the root causes of metabolic dysfunction, from gut health to hormonal imbalances, creating personalized nutritional and lifestyle strategies.
• Integrated Services: Our team works cohesively to offer a spectrum of care that includes personal injury rehabilitation, physical therapy, and nutritional counseling. This allows us to create a unified treatment plan in which a patient can receive a chiropractic adjustment to alleviate back pain, consult with a provider on evidence-based weight-management medications under medical supervision, and receive a personalized nutrition plan, all within one coordinated system.

This team-based approach ensures that we treat the whole person, not just the symptoms, embodying the principles of modern, patient-centered integrative care. Patients are not isolated body parts; a patient with obesity, diabetes, back pain, and depression needs a coordinated strategy that respects the whole person.

Deconstructing Obesity: A Chronic and Complex Disease

We must begin by framing obesity correctly. It is not a simple matter of choice or a lack of discipline. Obesity is a chronic, progressive, relapsing, and treatable disease. This perspective is fundamental to how we approach patient care. When patients stop their anti-obesity medications, the weight often returns. This is no different than when a patient stops their antihypertensive medication, and their blood pressure rises, or when they stop chemotherapy and a malignancy returns. The condition relapses because it is chronic and deeply embedded in our physiology.

Obesity is profoundly multifactorial. It involves intricate neurobehavioral, neuroendocrine, and metabolic components. The accumulation of excess body fat promotes adipose tissue dysfunction, which is a key driver of the chronic inflammation and metabolic chaos associated with the disease. Obesity affects the body through several overlapping mechanisms:

• Insulin resistance
• Chronic low-grade inflammation
• Leptin resistance
• Altered appetite regulation
• Reward pathway dysregulation
• Mitochondrial dysfunction
• Reduced skeletal muscle metabolic flexibility
• Gut-brain signaling changes
• Sleep disruption and cortisol imbalance
• Mechanical overload on the spine, hips, knees, and feet

The consequences are far-reaching, impacting every system of the body:

• Metabolic: Type 2 diabetes, dyslipidemia, hypertension.
• Biomechanical: Osteoarthritis, back pain, incontinence.
• Psychosocial: Depression, anxiety, social stigma, and discrimination.

In the United States, the statistics are sobering. 41.9% of the adult population meets the criteria for obesity (BMI ≥ 30), and a startling 9.2% have severe obesity (BMI ≥ 40). These numbers underscore the urgency of developing effective, accessible, and compassionate treatment strategies.

The Social and Environmental Drivers of Obesity

When we consider the roots of this epidemic, we must look beyond the individual to the broader environment. I often refer to the “social determinants of obesity” because factors like socioeconomic status, education, and environment play such a powerful role.

• Economic Instability: For centuries, poverty was associated with being underweight. Today, the opposite is often true. In many impoverished areas, access to fresh, nutrient-dense food is limited, while calorie-dense, processed foods are cheap and abundant. This creates an environment where metabolic disease can thrive.
• Neighborhood and Built Environment: If a person lives in a neighborhood where it is unsafe to walk outside, opportunities for regular physical activity are severely limited. The lack of green spaces, sidewalks, and recreational facilities contributes directly to a sedentary lifestyle.
• Genetic and Hormonal Factors: We are identifying an ever-growing list of genetic and hormonal players that regulate appetite and metabolism, including ghrelin (the “hunger hormone”), GLP-1 (a satiety hormone), and leptin (which signals fullness). Research into the gut microbiota is also revealing how the balance of our intestinal flora can profoundly influence weight.
• The Modern Environment: The rise of technology has engineered physical activity out of our daily lives. From desk jobs to digital entertainment, we are more sedentary than any previous generation.

Over the last decade, virtually every major medical organization, including the American Medical Association, has officially recognized obesity as a disease. This recognition is a critical step, as it validates the patient’s struggle and opens the door for proper diagnosis, treatment, and insurance coverage.

The Overwhelming Complexity of Appetite Regulation

The regulation of our appetite is an incredibly complex symphony conducted by the brain and a host of hormones. When you look at the intricate network of signals involved, it’s easy to see how a disruption in even one pathway can lead to dysfunction. Hormones like leptin, cortisol, ghrelin, and GLP-1 are in constant communication with the brain’s appetite centers, like the hypothalamus.

For many individuals with obesity, these signaling pathways are dysregulated. They may have leptin resistance, in which the brain doesn’t receive the “I’m full” signal, or ghrelin imbalances that drive persistent hunger. It becomes incredibly difficult for someone to “overpower” these potent neuroendocrine signals through willpower alone. This physiological reality is often overlooked, leading to significant clinical inertia.

Consider this shocking statistic: of the 100 million people with obesity in the United States, less than 1% receive a prescription for an anti-obesity medication. Less than 300,000 undergo bariatric surgery, despite 9.2% of the population having severe obesity. Why is there such a massive gap between the need for treatment and the care being provided? A large part of the answer lies in bias.

Binge Eating Disorder and the Physiology of Loss of Control Eating

A key concept in obesity care is recognizing binge eating disorder (BED). Binge eating disorder is not simply eating too much. It involves eating, within a discrete period of time, an amount of food larger than most people would eat under similar circumstances, combined with a sense of loss of control during the episode.

Clinically, binge eating episodes are often associated with several features:

• Eating much more rapidly than normal
• Eating until uncomfortably full
• Eating large amounts when not physically hungry
• Eating alone because of embarrassment
• Feeling disgusted, depressed, guilty, or ashamed afterward
• Marked distress about binge eating
• Episodes occurring at least once weekly for at least three months
• Absence of compensatory behaviors, such as purging, that would suggest bulimia nervosa

In practice, patients may describe getting up at night to eat while family members are asleep, hiding food, eating in the car, or waking up the next morning feeling shame and physical discomfort. I approach these disclosures with compassion because shame worsens the cycle. Patients need an evidence-based treatment plan, not judgment.

The physiology behind binge eating disorder involves dysregulation of:

• Dopamine reward pathways
• Impulse control circuits
• Stress-related cortisol signaling
• Serotonin and norepinephrine pathways
• Prefrontal cortex regulation
• Gut-brain satiety signaling
• Emotional regulation networks

From a clinical standpoint, binge eating disorder can drive weight gain, worsen insulin resistance, aggravate depression and anxiety, and contribute to musculoskeletal pain because additional body mass increases mechanical load across the spine and joints.

Confronting Weight Bias: The Last Socially Acceptable Discrimination

Weight bias and stigma are perhaps the greatest barriers to effective obesity care. There is a pervasive, often unconscious, belief in our society—and even within the medical community—that obesity is a character flaw, a result of laziness or a lack of willpower. This prejudice is not only hurtful but also dangerous.

Research has shown that patients who experience weight bias have increased complications and mortality, independent of their BMI. The bias itself, through the stress it causes and the lack of care it fosters, becomes a risk factor. What drives this?

• Lack of Reimbursement: Historically, treatments for obesity, especially medications, have not been well-covered by insurance, discouraging providers from offering them.
• Time Constraints: Meaningful lifestyle counseling takes time, a luxury many providers in a fee-for-service model do not have.
• Cultural Stigma: The belief that “people should just try harder” prevents us from treating obesity with the same seriousness as other chronic diseases.

This bias manifests in shocking ways. Imagine if we told patients with schizophrenia to “just stop listening to the voices.” It sounds absurd, yet we often tell patients with obesity to “just eat less and move more,” ignoring the powerful physiological drivers of their condition. We require extensive psychological screening for bariatric surgery patients—a practice not required for equally life-altering procedures like coronary artery bypass grafts—based on the biased assumption that overeating is purely a behavioral problem.

In a landmark Harvard study on implicit bias, weight bias was the only form found to increase over time. As providers, we must be the ones to break this cycle.

Shifting the Conversation: How to Engage Patients Effectively

The first step in combating bias is to change the way we talk to our patients. We need to approach the conversation with empathy, respect, and a genuine desire to help. The 5 A’s model provides a great framework:

• Ask: “Is it okay if we talk about your weight and its potential effects on your health?” This simple question asks for permission and shows respect for the patient’s autonomy.
• Assess: Take a detailed history. Understand their weight journey, family history, what they’ve tried in the past, and their understanding of how weight impacts health.
• Advise: Provide clear, non-judgmental advice. Explain that even a modest weight loss of 3-5% can lead to significant improvements in blood pressure, blood sugar, and cholesterol.
• Agree: Work with the patient to set realistic, achievable goals. What is a goal weight they feel is sustainable?
• Arrange/Assist: Connect them with the resources they need. This could be a referral to a dietitian, an exercise program, or a discussion about pharmacotherapy or surgical options.

This approach transforms the conversation from one of judgment to one of partnership. Shared decision-making improves adherence because the patient becomes an active participant rather than a passive recipient.

A Framework for Treatment: Lifestyle, Medication, and Surgery

Our treatment approach is tiered and personalized, based on BMI and the presence of comorbidities (obesity-related health conditions). Current research strongly supports the idea that obesity should be treated as a chronic disease requiring ongoing monitoring, not as a temporary problem solved by short-term dieting. The Endocrine Society, American Gastroenterological Association, and American Diabetes Association emphasize that structured lifestyle therapy, medication when appropriate, and long-term follow-up are essential for improving outcomes (Apovian et al., 2015; American Diabetes Association Professional Practice Committee, 2026; Grunvald et al., 2022).

• Lifestyle Interventions (BMI ≥ 25 with comorbidities, or ≥ 30): This is the foundation for everyone. It includes healthy eating, regular physical activity, and behavioral therapy. As a chiropractor and functional medicine practitioner, I often begin here, helping patients build a sustainable foundation. We focus on anti-inflammatory food plans, stress management techniques, and personalized exercise regimens that account for any musculoskeletal limitations.
• Pharmacotherapy (BMI ≥ 27 with comorbidities, or ≥ 30): Medications should be considered for patients who have not reached their goals with lifestyle changes alone. These are not “magic pills” but powerful tools to aid the biological processes of appetite and metabolism.
• Bariatric Surgery (BMI ≥ 35 with comorbidities, or ≥ 40): For individuals with severe obesity, surgery remains the most effective long-term treatment for significant weight loss and remission of comorbidities. It is a vital option that is tragically underutilized. A shocking 71% of providers never discuss surgical options with eligible patients.

Our goal is typically a 5-10% reduction in total body weight over six months. This level of weight loss is clinically significant and can dramatically reduce health risks.

Why “First, Do No Harm” Matters in Obesity Treatment

One of the most important principles I use in integrative obesity care is “first, do no harm.” Before adding a new medication or supplement, I want to understand whether the patient is already taking medications that may be contributing to weight gain. Common obesogenic medications may include:

• Antidepressants and Antipsychotics: (e.g., some SSRIs, mirtazapine, olanzapine)
• Anticonvulsants/Mood Stabilizers: (e.g., valproate, gabapentin)
• Antidiabetic Agents: (e.g., sulfonylureas, insulin)
• Corticosteroids: (e.g., prednisone)
• Certain beta-blockers
• Certain antihistamines
• Some hormonal therapies

Shockingly, patients with obesity are often prescribed these medications more frequently. If a patient is on one of these drugs and struggling with their weight, we collaborate with their prescribing physician to see if a weight-neutral or weight-loss-promoting alternative exists. For instance, a patient with diabetes on a sulfonylurea like glyburide might be a candidate for a GLP-1 receptor agonist or an SGLT2 inhibitor, which can aid in weight loss. This is a perfect example of how the collaboration between Dr. Cardenas and me benefits the patient, ensuring patient safety and optimized outcomes.

Modern Pharmacotherapy for Weight Management

The good news is that we now have a growing arsenal of safe and effective long-term medications for obesity. All approved medications are more effective than placebo. A 12-week trial is often sufficient to determine whether a medication is working for a patient. If a patient does not achieve at least a 5% reduction in body weight after approximately 3 months at a therapeutic dose, we reassess the plan.

Here is an overview of some key long-term options:

• Phentermine/Topiramate (Qsymia): This combination drug pairs a well-known appetite suppressant (phentermine) with an anticonvulsant (topiramate) that also reduces appetite and may lower leptin levels. Because phentermine can stimulate the sympathetic nervous system, increasing heart rate and blood pressure, it requires careful dose titration and monitoring, especially in patients with cardiovascular concerns.
• Naltrexone/Bupropion (Contrave): This combination works on the brain’s reward and appetite-control centers. Bupropion stimulates the POMC system to reduce appetite, while naltrexone blocks an inhibitory feedback loop, allowing the appetite-suppressing effect to persist. This may be particularly useful for patients with co-occurring depression or reward-driven eating patterns.
• Orlistat: This medication works by inhibiting gastrointestinal lipases, thereby reducing the absorption of dietary fat. It is a non-stimulant option but can cause gastrointestinal side effects and may interfere with the absorption of fat-soluble vitamins (A, D, E, K), requiring monitoring.
• Liraglutide (Saxenda): A daily injectable GLP-1 receptor agonist. GLP-1 is a natural gut hormone that slows stomach emptying, promotes feelings of fullness (satiety), and acts on the brain’s appetite centers. It is started at a low dose and titrated up to 3.0 mg daily to manage potential GI side effects like nausea.
• Semaglutide (Wegovy): A weekly injectable GLP-1 receptor agonist. It works similarly to liraglutide but has a longer half-life, allowing for once-weekly dosing. It has demonstrated even greater weight loss in clinical trials, with an average loss of approximately 15% of body weight (Blundell et al., 2017; Wilding et al., 2021). It is important to note that semaglutide is sold as Ozempic for type 2 diabetes and Wegovy for chronic weight management; they are the same molecule but have different indications and dosing.
• Tirzepatide (Zepbound): A novel weekly injectable that is a dual GIP/GLP-1 receptor agonist. By targeting two different incretin hormone pathways, it produces a powerful synergistic effect on appetite suppression and glucose control. Clinical trials have shown unprecedented levels of weight loss, with some participants achieving more than a 20% reduction in body weight (Jastreboff et al., 2022). This potent therapy may be particularly appropriate for patients with severe obesity.
• Lisdexamfetamine (Vyvanse): While not approved for general obesity, this medication is FDA-approved for moderate to severe binge eating disorder (BED). Since BED is a common co-occurring condition in patients with obesity, identifying and treating it can be a critical part of the overall weight management strategy. It works on dopamine and norepinephrine pathways to improve impulse control (McElroy et al., 2015).

Emerging Obesity Medications and Future Directions

The obesity medicine pipeline is advancing quickly. Researchers are studying therapies that may produce even more substantial weight loss while improving metabolic markers. Emerging therapies include:

• Retatrutide: A triple agonist targeting GLP-1, GIP, and glucagon receptors, which has shown very large weight reduction percentages in trials (Jastreboff et al., 2023).
• Oral GLP-1 agonists: Medications like orforglipron and danuglipron are being developed to provide an oral alternative to injections.
• Combination therapies: CagriSema, a combination of cagrilintide and semaglutide, is being studied for its synergistic effects on appetite and metabolism.

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Discovering the Benefits of Chiropractic Care- Video

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The Role of Integrative Chiropractic Care in Weight Management

So, where does integrative chiropractic care fit into this modern, medical approach? It is a crucial component of our holistic model, addressing the biomechanical consequences of excess weight and enhancing the body’s ability to heal and adapt.

1. Addressing Biomechanical Pain: Excess weight places tremendous stress on the musculoskeletal system, leading to conditions like osteoarthritis, degenerative disc disease, and chronic back and joint pain. In my clinical observations, I frequently see patients whose weight-related concerns overlap with low back pain, sciatica, and knee pain. This pain creates a vicious cycle: it hurts to move, so the person becomes more sedentary, which can lead to further weight gain. Through precise chiropractic adjustments, spinal decompression, and soft tissue therapies, we can alleviate pain, improve joint function, and restore mobility. This enables patients to engage in the physical activity essential for weight loss.
2. Improving Neurological Function: The spine houses the central nervous system, which is the master controller of all bodily functions, including metabolism and hormonal regulation. By correcting spinal misalignments (subluxations), we can reduce interference in the nervous system, potentially improving the body’s ability to self-regulate and heal.
3. Functional Medicine and Lifestyle Coaching: As a practitioner certified in functional medicine, I look beyond the symptoms to find the underlying root causes of dysfunction. We may use advanced testing to assess gut health, hormonal imbalances, or nutrient deficiencies that contribute to weight gain. Based on these findings, we develop highly personalized nutrition plans, stress-reduction protocols, and targeted supplement recommendations to optimize metabolic function from the inside out.
4. Rehabilitation and Muscle Preservation: A major concern with weight loss, particularly rapid loss, is the loss of lean muscle mass. Muscle is critical for resting metabolic rate, glucose disposal, and long-term weight maintenance. My clinical approach, as reflected on my professional platforms like ChiroMed and my LinkedIn profile, emphasizes a rehabilitation-focused plan that includes progressive resistance training, core stabilization, and balance work to preserve this metabolically active tissue. Movement is metabolic medicine.

By integrating these approaches under the medical direction of Dr. Cardenas, we ensure that the patient is supported on every level—structurally, neurologically, metabolically, and medically.

Final Clinical Takeaway

If there is one concept I want patients and clinicians to remember from this post, it is this: obesity care must be individualized, medically safe, and integrated. Before adding a medication, we must ask whether current medications are worsening weight gain. Before recommending exercise, we must ask whether pain, injury, or joint dysfunction is limiting movement. Before assuming noncompliance, we must ask whether binge eating disorder, depression, anxiety, or sleep apnea are present.

With the collaborative oversight of Dr. Maria Guadalupe Cardenas, MD, and the integrative chiropractic, functional medicine, and rehabilitation services I provide, our El Paso practice model is designed to evaluate the whole patient. Modern obesity medicine is no longer about simply telling people to eat less and move more. It is about understanding physiology, reducing harm, improving function, supporting the nervous and musculoskeletal systems, and applying evidence-based tools with compassion and precision. This is the future of effective and compassionate obesity care.

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References

• American Diabetes Association Professional Practice Committee. (2026). Standards of Care in Diabetes 2026. Diabetes Care.
• Apovian, C. M., Aronne, L. J., Bessesen, D. H., McDonnell, M. E., Murad, M. H., Pagotto, U., Ryan, D. H., & Still, C. D. (2015). Pharmacological management of obesity: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(2), 342–362. https://doi.org/10.1210/jc.2014-3415
• Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes, Obesity & Metabolism, 19(9), 1242–1251.
• Grunvald, E., Shah, R., Hernaez, R., Chandar, A. K., Pickett-Blakely, O., Teigen, L. M., Yanovski, S. Z., & Singh, S. (2022). AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology, 163(5), 1198–1225. https://doi.org/10.1053/j.gastro.2022.08.045
• Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., & Stefanski, A. (2022). Tirzepatide once weekly for the treatment of obesity. The New England Journal of Medicine, 387(3), 205–216.
• Jastreboff, A. M., Kaplan, L. M., Frías, J. P., Wu, Q., Du, Y., Gurbuz, S., Coskun, T., Haupt, A., Milicevic, Z., Hartman, M. L., & Retatrutide Phase 2 Obesity Trial Investigators. (2023). Triple-hormone-receptor agonist retatrutide for obesity: A phase 2 trial. The New England Journal of Medicine, 389(6), 514–526. https://doi.org/10.1056/NEJMoa2301972
• McElroy, S. L., Hudson, J. I., Mitchell, J. E., Wilfley, D., Ferreira-Cornwell, M. C., Gao, J., Wang, J., Whitaker, T., Jonas, J., & Gasior, M. (2015). Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder. JAMA Psychiatry, 72(3), 235–246. https://doi.org/10.1001/jamapsychiatry.2014.2162
• Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine, 384(11), 989–1002.

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