phentermine doctor in charlotte

Most Common Mistakes People Make with Phentermine

Phentermine is an FDA approved weight loss medication that is used to control appetite, it is approved for individuals with a body mass index (BMI) that meets medical criteria for obesity – a BMI over 30 kg/m2 or a BMI over 27 kg/m2 with obesity related medical conditions such as high blood pressure, sleep apnea, or weight related joint pain. Phentermine effectively reduces hunger, cravings, and increases metabolism and for these reasons phentermine is a popular medication used for obesity and medical weight management. Phentermine is the oldest and arguably one of the most effective weight loss medications on the market, to add, it is the cheapest weight loss medication and therefore easy to access in most pharmacies across the country. Phentermine is the most commonly prescribed weight loss medication in the United States, however, despite phentermine’s vast use and longevity on the market there are common mistakes that patients make that can reduce short and long-term weight loss success.

Not Eating Enough and Skipping meals


I know what you’re thinking, isn’t the point of phentermine to NOT eat? No, it’s not. This is one of the biggest misconceptions with phentermine. Phentermine is not a starvation pill! The purpose of phentermine is to help control weight gaining signals in the body such as uncontrolled appetite, excess hunger, increased fat storage, poor food choices, and slow metabolism to aid in weight loss. Phentermine’s primary mechanism of action is to reduce appetite, however, not eating or skipping meals is not the goal and will lead to more problems in the long run. Many are aware that muscle weighs more than fat, when we lose muscle during a starvation or restriction diet it can be very exciting to see large weight loss on the scale, however, the muscle loss will eventually turn into a reduction in basal metabolic rate (BMR) which will make future weight gain easier. This is one phenomenon that can occur when patients misuse phentermine, they lose large amounts of weight to only gain it all back in a few months.

The next reason for Proper nutrition is imperative for all human beings, we all need the right combination of micro and  macronutrients in order to survive, using phentermine to aid in starvation is not the right method for weight  loss, primarily because it will not last beyond a few months and additionally because it can lead to poor nutrition and Many people using phentermine tend to make the mistake of starving themselves for too long, thinking this will stimulate the weight loss process.

Poor Diet and Improper Nutrition


Nutrition is the nourishment for humans responsible for health, wellness, and growth. The body needs nutrition. There are different schools of thought on the amount, timing, and type of nutrition but the one thing that we can all agree on is that a body lacking proper micro and macronutrients will not survive.

Poor or malnutrition can range from inadequate vitamins, minerals, micro and macronutrients to excess “bad” or toxic foods that can lead to various diseases and increased morbidity. Phentermine is a tool that helps reduce the intense hunger and many of the cravings for the wrong foods that lead to weight gain so that individuals can focus on the right foods, smaller portions, and proper nutrient balance. Proper nutrition will not only maximize weight loss results, increase energy and overall performance, but will reduce nutritional deficiencies, fatigue, and the rebound hunger and cravings that occur as a result of “crash diets”

Overestimate Phentermine


FDA approved weight loss medications are great tools; however, they are not magic pills. There is no magic, all weight loss occurs from controlling negative physiology that leads to weight gain and introducing positive habits and physiology centered around weight loss. Weight loss physiology involves more than just diet and exercise, there are multiple factors such as proper stress management, sleep, hormonal balance, environment, emotions, and many more. When individuals overestimate the effect of phentermine they are setting themselves up for disappointment. The medication has a wide range of effectiveness that is dependent on the person taking the medication along with their medical and obesity history, habits, other medications, and various other factors. Phentermine does not work for everyone, although there are individuals who will have a great response with phentermine for several months there are some who will have absolutely no response with phentermine, others who will have minimal to limited effect, and several who will have an effect that may quickly wear off. Phentermine works best in coordination with a proper diet and adequate physical activity, taking phentermine without changing poor habits will not create long-term weight loss and will increase the likelihood of future weight regain.

Taking Phentermine at the Wrong Time


Phentermine is a once a day medication that should be taken first thing in the morning. Taking the medication on an empty stomach or with food is not as important as making sure to take it early in the day. One of the side effects of phentermine is energy and focus which can lead to insomnia or trouble sleeping. The likelihood of insomnia increases the later in the day that the medication is consumed. It is important to that the medication in the morning so that sleep quantity and quality is uninterrupted, it’s important to remember that proper sleep is equally effective for weight loss.

Skipping or Forgetting to take Phentermine


It is important to take all medications as directed by the doctor, phentermine is no different. Taking phentermine daily especially in the beginning is very important. While phentermine is aiding in appetite reduction, increased metabolism, and elevated energy, stopping the medication or skipping phentermine can have the opposite effects. Premature discontinuation of phentermine may lead to intense hunger, cravings, and fatigue.

Phentermine is a great tool for managing and treating the disease of obesity, however, it is imperative to use under direct supervision of a physician or medical weight loss doctor and as directed with a comprehensive weight loss program.


Want to learn more?


Watch Dr Covington’s video discussing the most common mistakes people make with phentermine

Watch Dr Covington’s live video discussing phentermine and how it works


Does Lyrica cause weight gain?

Does Lyrica Cause Weight Gain?

Medication induced weight gain is a well-known phenomenon in bariatrics and occurs with some of the most commonly prescribed medications, such as insulin, antihistamines, and steroids.

Does Lyrica cause weight gain?

Yes. It certainly can but as with everything in the medical field it depends on the individual and several other variables. Lyrica and its popular predecessor Gabapentin (Neurontin) have both been shown to cause significant weight gain. In a 2008 study, patients taking Lyrica for epilepsy, gained approximately 4 kg (8 lb) in a 3 to 6-month period. The amount of weight gained increased with escalating doses of Lyrica, with the largest amounts of weight gained with the 600 mg daily dose.

Are there alternatives for patients gaining weight with Lyrica?

It is important before stopping any medications that you first discuss your concerns with your doctor. There are side effects to not only taking medications but also stopping them abruptly. Next, it is important to understand that some medications are lifesaving and the risk of side effects such as gaining weight may outweigh the risk of a major medical event. In the case of Lyrica, it is indicated for several conditions such as epilepsy, neuropathic pain, and fibromyalgia, therefore, the burden of treatment depends on the reason for taking the medication. In the case of seizure treatment, for example, this decision will heavily depend on the best medication for managing seizure activity.

Have you gained weight from medication and need help getting it off?

Check out our blog article: How to Choose a Weight Loss Doctor 

Alternatives for Seizure Disorder

Lyrica is indicated as an adjunct to seizure therapy for partial onset seizures (also known as simple seizures). For individuals looking to lose weight, topiramate (or Topamax) is a reasonable alternative. This anti-epileptic medication has been shown to induce weight loss and reduce binge eating. In a study published in the Obesity Reviews Journal, individuals taking Topirmate for 16 weeks lost approximately 5 kg (10 lbs).  In addition, individuals taking topiramate continued losing weight for the duration of the trial. Due to the promise of effective weight loss the extended release version of topiramate was added in combination with phentermine in the FDA approved weight loss medicine Qsymia. Other alternative anti-epileptics that do not cause weight gain include Lamotrigine, Phenytoin, and Zonisamide. These medications are “weight neutral”, meaning they neither cause weight gain or weight loss.

Lyrica in Diabetes

Lyrica is often used in diabetes for peripheral neuropathy or nerve pain. Patients with diabetes have a propensity to gain weight due to changes in metabolism, the nature of the disease, and the physiological response to carbohydrates and exogenous insulin. Therefore, adding yet another weight gaining medication should be avoided when possible. For diabetic neuropathy, diabetes and blood glucose control are the most essential strategies for reducing neuropathy. The first step to managing blood glucose is eating a diet low in simple, refined, and processed carbohydrates and remaining compliant with anti-diabetic medications (at least until they can be titrated down or off). For diabetes, adequate physical activity aids in glucose control as well by increasing basal metabolic rate, moving glucose into healthy lean muscle, and lowering insulin resistance. The adult physical activity recommendation for individuals with diabetes is 60 minutes a day, 6 days a week.

Lyrica for pain and other neuropathies

The #1 cause for peripheral neuropathy is diabetes but it can also be caused by malnutrition, alcoholism, shingles, and B12 deficiency. Therefore, the alternative treatments for these conditions is managing the underlying issue. For example, in the case of vitamin B12 deficiency, individuals lacking B12 in the diet should ingest foods high in B12 such as liver, beef, tuna, pork chops, oysters, cottage cheese, yogurt, eggs, ready to eat cereals, and milk. For those unable to eat foods high in B12, such as vegans or vegetarians, they should opt for vitamin supplementation. For individuals with fibromyalgia, exercise and food sensitivity testing have been found to provide hope for long-term solutions.

Have more weight related questions? Read our section: Dr Covington answers your questions for more 

DeToledo JC, Toledo C, DeCerce J, et al. Changes in body weight with chronic, high dose gabapentin therapy, Ther Drug Monit 1997; 19:394-6.

Hoppe C, Rademacher M, Hoffman JM et al. Bodyweight gain under pregabalin therapy in epilepsy: Mitigation by counseling patients? Seizure 2008; 17:327-32.

Kramer CK1Leitão CBPinto LCCanani LHAzevedo MJGross JL. Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials. Obes Rev. 2011 May;12(5):e338-47. doi: 10.1111/j.1467-789X.2010.00846.x. Epub 2011 Mar 28.

phentermine blog pic-min

How Phentermine aids in Weight Loss

Phentermine or Adipex is commonly used for weight loss in combination with diet and exercise. Although phentermine is one of the oldest FDA approved weight loss medications on the market there are still a lot of questions regarding its safety and efficacy. Does phentermine work long term?  Is phentermine necessary for weight loss? Is phentermine safe? All of these questions are valid. To answer these concerns along with how the most commonly prescribed weight loss medication in America aids in weight reduction we will explore a few key factors, starting with phentermine’s mechanism of action.

How Phentermine Works

Phentermine is a medication that is only available by prescription. It requires physician monitoring because it is categorized as a “controlled substance”. Phentermine is not a magic pill, it is simply a tool used to help with weight loss. The mechanism of action for phentermine causes a release of norepinephrine from the brain. Norepinephrine (also known as adrenaline) is a natural neurotransmitter produced and released in the body. This chemical is present when we are afraid, nervous, or involved in an action that requires energy, such as moderate to rigorous exercise or running from a bear (hopefully the latter never happens). As luck would have it, the release of norepinephrine from the brain also happens to promote several weight reducing activities such as appetite suppression, heightened attention and awareness, increased circulation of oxygen and nutrients throughout the body and increased metabolism. The increased oxygen circulation increases oxygen supply to the brain, which allows for rapid decision-making, and the activation of large skeletal muscles, which allows us to run from danger if necessary. This cascade of events is called the “fight or flight” response.

In addition to appetite suppression, norepinephrine reduces the thoughts, obsessions, and preoccupations with food. This is why some individuals taking phentermine may forget to eat because they don’t even think about food anymore. The metabolic increase from norepinephrine causes an increased use of stored body fat and an increased uptake of calories at rest in a 24-hour period.

If you are wondering why we don’t experience weight loss on a normal daily basis due to this presence of norepinephrine, it’s simply because norepinephrine only sticks around for a few seconds before it is broken down by the body.

Now that you understand how norepinephrine works, you also understand how phentermine works, it causes a release of norepinephrine and therefore turns on fat burning and counteracts the body’s natural resistance to weight loss.

How much weight will you lose on phentermine?

For all FDA approved weight loss medications, results will vary. On average individuals using phentermine can expect to lose twice the amount of weight that they would lose with diet and exercise alone. This means that if the average rate of weight loss is 8-10 pounds a month that a patient on phentermine may lose twice this rate, 16-20 pounds a month. This is of course considering that there are no counteractive medications, medical conditions, or other hindrances.  It is normal for the weight loss seen in the first few weeks to slow down to a more steady pace over time. This will occur even more for individuals closer to ideal weight. The most significant results, however, are those witnessed by the truly weight loss resistant. This is the individual who fails to lose weight despite multiple attempts over an extended period of several years. For this individual, phentermine can be the catalyst to finally turn on fat burning and when this occurs any weight reduction is extraordinarily significant!

What not to do on phentermine – the “Phentermine Commandments”

  • Thou shalt not skip meals
  • Thou shalt not severely restrict calories
  • Thou shalt not rush the process
  • Thou shalt not ignore nutrition and macronutrient balance
  • Thou shalt not ignore physical activity
  • Thou shalt not skip doctor’s appointments or routine monitoring


Despite the weight loss achieved while taking phentermine resist the urge to skip meals or severely restrict calories because this will only backfire long term. Also resist the urge to speed up weight loss results or create unrealistic demands. Keep in mind that phentermine is a weight loss tool, not a Genie in a Bottle, you cannot expect to lose all of your excess weight overnight.

What to expect when starting phentermine? Is phentermine safe?

Phentermine, like any medication, is safe when used for the right patient and when prescribed by a knowledgeable and experienced physician. Many medications can be refilled without routine check-ins with the doctor, however, phentermine is not one of those medications. Phentermine requires routine monitoring, physical examinations, vital sign checks, and regular office visits to discuss side effects.

What are the most common side effects for phentermine

The symptoms caused by phentermine will vary according to the patient but the most common side effects are appetite suppression and thirst. Thirst can occur as early as the first day and is easy to fix by simply drinking plenty of water. Other common symptoms are increased energy which can lead to insomnia or trouble sleeping. For this reason, it is recommended to take phentermine first thing in the morning. Thirst and insomnia typically subside after the first few weeks but for individuals with severe insomnia your doctor may decide to avoid phentermine altogether. Phentermine can also increase anxiety and other mental diseases such as bipolar disorder. Lastly, the most significant side effect of phentermine is an increase in heart rate and blood pressure along with heart palpitations. All of these symptoms along with other less common side effects not mentioned in this article must be monitored by a doctor.

Is phentermine addictive?

The short answer is not typically. Phentermine is in the class of medications known as amphetamines due to it’s chemical structure and action in the brain. However, it is not a chemical that patients typically get addicted to. Individuals who have successfully lost weight with phentermine may develop a psychological dependence, meaning they may emotionally feel fearful of regaining weight off the medication or feel like they are unable to make healthy decisions without taking phentermine. Some may even notice a physical increase in hunger and cravings once no longer taking the medication.

Will phentermine stop working over time?

It depends. For some people the answer is yes, after several months appetite suppression will subside.  For others, the effects of phentermine remain for a much longer period. Phentermine is not effective for everyone. If phentermine is ineffective for weight loss, meaning an extensive plateau, lack of appetite suppression, or minimal to no weight loss results over an adequate period, it should be discontinued. In this event, a weight loss doctor like Dr Covington can recommend an alternative treatment or FDA approved weight loss medication for you.

Phentermine requires a comprehensive weight management plan

This medication promotes weight reduction by providing energy, focus, suppressing food intake and reducing the desire to eat. Individuals undergoing a weight loss plan are able to make healthier food choices and pursue physical activity without hunger and fatigue. However, this medication is most effective when combined with a comprehensive weight management plan that includes medical oversight, nutrition, physical activity, and routine medical monitoring.

Want to learn more? Watch Dr Covington’s live video discussing phentermine and how it works.

what are the causes of obesity?

Obesity is Not Just Calories In and Calories Out. Here’s Proof

Understanding Causes of Obesity

I attended a networking event this past weekend and I had the pleasure of meeting a young physical trainer aspiring to expand his personal fitness brand. I questioned him on his experience with training clients over 300 lbs and he was honest to state that he had never trained anyone this size. He then went on to say, “at that weight it’s all about diet, so I would cut down their calories and tell them to walk for 40 minutes a day”. I smiled and shook his hand to continue through the crowd of attendees but his statement stuck with me for hours and not in a positive way. I certainly understand his approach, perhaps he was thinking that in order to maintain a 300 lb frame the caloric intake would need to be approximately 4200 calories so reduce calories and increase energy expenditure and voila, we get weight loss. The approach is simplistic and works in some individuals but does not account for basal metabolism, hormone balance, or fat regulation. I would caution applying the calorie and exercise equation to a client without more depth, specificity, or validity. We have all witnessed the individual who is working out excessively and eating a restricted diet to only gain or merely maintain weight. Oftentimes these individuals are blamed for cheating on their diet but the truth is, their weight loss plan may just not work for their sub-type of obesity.

Excess calories and a sedentary lifestyle can certainly lead to excess weight but they are not the only causes for weight gain.

There are over 50 varieties of obesity!

My discussion with this gentleman lead me to write this post and share the various types and causes of obesity. The list below is derived from lectures, presentations, and published articles quoting my adopted mentor Dr. Lee Kaplan, MD, PhD and Medical Director of the Massachusetts General Hospital Weight Center Program. I remember the first time that I heard Dr. Kaplan speak, I was in the last weeks of my internal medicine residency in Charlotte, NC and he was explaining the intricate pathways involved in obesity and the disease of obesity. I was fascinated. In all of my medical training I had never heard anyone explain the complexity of weight in this way. It revolutionized the way that I practice weight management and taught me that obesity is so much more than just diet and exercise alone.

Types of Obesity

Genetic/Congenital and Syndromic Receptor or Hormone Deficiency Neurologic Metabolic Lifestyle Related or Induced Other
-Prader-Willi Sydrome


-Bardet Biedl Syndrome

-Fragile X

-Cohen Syndrome

-Carpenter Syndrome

-Albright Osteodystrophy

-Alstrom Syndrome

-BFL Syndrome

-Ayazzi Syndrome

-MOMO Syndrome

-Rubenstein-Taybi Syndrome

-Leptin Hormone Deficiency

-Leptin Receptor Deficiency

-POMC Deficiency

-MC4R Deficiency

-Alpha-MSH Deficiency

-Sim-1 Deficiency

-PC-1 Deficiency

-KSR2 Deficiency

-MRAP2 Deficiency

-SH2B1 Deficiency

-BDNF Deficiency

-trkB Deficiency

-Central -Hypothalamic



-Healthy Metabolic

-Thermogenesis Deficient


-Insulin Induced


-Progesterone Induced

-Psychotropic Induced

-Antibiotic Induced

-Endocrine Disorder Cushings, Diabetes

-Endocrine Disruptor




-Early Childhood


-Diet Dependent

-Exercise Sensitive

-Sleep Sensitive

-Phentermine responsive

-Lorcaserin responsive

-Topiramate responsive


-Bupropion responsive

-GLP-1 responsive

-Bypass surgery responsive

-Bypass surgery resistant

-Gastric band responsive

-Viral Adenovirus

-Peripheral related


Adapted from Presentations by Lee Kaplan, MD, PHD and publication Your Weight Matters, Fall 2016

Chart and Classification is Original ContentCopyright 2017 © Melody Covington MD, Abundant Health & Vitality Inc

Diet and exercise will always be the foundation for weight loss. We are learning so much about obesity and how to treat it. It is time to reject the notion that diet and exercise alone are the cure for excess weight. It is also time to stop overestimating the impact of exercise, it is much more essential for weight maintenance than weight loss. As listed in the chart above diet and exercise are not the only causes of obesity, so it can also no longer be our only treatment.