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.

obesity and exercise

Obesity and Exercise

Most people agree that physical activity is an essential component to maintaining a healthy lifestyle. However, it is important to acknowledge that there are challenges to exercise that individuals with overweight and obesity often experience. There’s much more to the “just move more” advice for weight loss. We will explore a few challenges to exercise and potential solutions in this article.

#1. Exercise Is Difficult and Uncomfortable

Exercise does not have to be difficult. Obesity specialists often exchange the term exercise for physical activity. Exercise is associated with a negative connotation of arduous, unobtainable, and unenjoyable labor. This creates a mental barrier for many people. Physical activity is more acceptable and conveys simply moving. Physical activity can involve parking farther from the store, taking the stairs instead of the elevator, or breaking up an hour walk in 10 minute increments over a six-hour period; all are suitable means of obtaining daily physical activity. The adult recommendation for physical activity is one hour a day, most days of the week, and this can be easily obtained by walking one hour a day. This is easy, safe, and can be very enjoyable. To add, walking is effective for both the weight loss and maintenance stages of weight management.

#2. Physical Activity Increases Hunger and Cravings

As the body increases energy expenditure in the form of increased physical activity, systems within the body will work to defend the set point (the body’s programmed weight locked within the hypothalamus). As more calories are burned, the body will compensate for the loss in fat by increasing hunger signals and reducing satiety. This leads to overeating, large portions, and ingestion of comfort foods. The end result is eating back calories lost from physical activity. To combat this physiological routine, first always eat properly and do not “over-diet.”

During the weight loss process it is tempting to cut calories too low, and this causes key nutrients to be lost as well. Although the scale may go down quicker in the beginning, it is deceiving; the weight loss is typically only water and muscle weight and not fat. Severe caloric restriction not only results in muscle loss but reduces metabolism, making it harder to lose additional weight (weight loss plateau) and easier to gain subsequent weight. This cycle also leads to even more food cravings!

When increasing physical activity, always start with a well-balanced and proper diet. Eat adequate protein and healthy fats to reduce food cravings and help with satiety. In addition, be sure that the feelings or thoughts of hunger and craving are legitimate. “Head hunger” is more related to a psychological hunger than a true physical hunger and is natural when making dietary changes. Cravings are sometimes related more so to habits than true physiological need for a nutrient or food. Obesity is a disease and for individuals who need to lose weight to eliminate chronic medical conditions or prevent disease, it is sometimes necessary to employ the help of an obesity clinician well-versed in FDA-approved weight loss medication to help with hunger, cravings, and metabolic preservation.

#3. Individuals with Overweight and Obesity Are More Prone to Workout Injuries

This can be true depending on the extent of excess weight and the types of physical activity. Increased torque on weight-bearing joints, especially the knees and ankles, can increase the risk of injuries for individuals carrying excess weight. It is important to avoid injuries that can lead to diminished mobility, as this will not only reduce confidence in physical activity but also increase the risk of additional weight gain. Stretching, slow progression, working with certified physical instructors experienced in bariatrics, and patience are key to starting an exercise regimen. Proper nutrition, rest, and listening to the body to differentiate muscle growth from dangerous muscle pain are also key to avoiding injuries from physical activity. For individuals with 100 or more pounds of excess weight, consider starting with chair exercises, water aerobics, and bike riding. These activities are safer, gentler on the joints and still effective for cardiovascular fitness and weight reduction.

#4. Consistency Is Hard

Physical activity is one of the most essential factors to weight maintenance; however, consistency is extremely difficult to maintain. Exercise serves as a great buffer in weight maintenance because caloric intake, stress, sleep patterns, food intake, and metabolism will not be consistent. As caloric intake and other metabolic factors fluctuate, physical activity serves as a method for energy expenditure to offset factors that impede weight loss. Ways to increase consistency with physical activity include: finding an activity that is enjoyable, creating accountability (can be in the form of fitness trackers, calendars, and accountability partners), and group fitness.

Exercise is not always easy, yet it is often suggested as a solution to weight loss as if it were effortless. It is important to remember that there are several challenges that create boundaries for engaging in physical activity. Finding strategies to overcome barriers to physical activity is essential to obtain physical fitness goals and ensure not only proper weight loss, but most importantly weight maintenance.

This blog article was originally written by Dr Melody Covington MD for the Obesity Medicine Association and can be found in their weight management blog section.

Is obesity a disease?

Why Is Obesity a Disease?

The American Medical Association (AMA) designated obesity a disease in 2013 and as a result, the idea that obesity is caused by insufficient willpower, lack of discipline, and bad choices began to transform. The headlines, “AMA Recognizes Obesity as a Disease” were catapulted across both academic and mainstream media. Obesity was no longer a conversation topic tucked away in a dusty corner but was instead sprinkled across national news for the public to scrutinize. From “TED Talks” to The New York Timesobesity specialists were asked to “weigh in” on this groundbreaking and somewhat controversial topic and to answer the question, “is obesity a disease?”

Now, four years later, the debate continues. Is obesity a disease? For some, obesity as a disease invalidates the importance of discipline, proper nutrition, and exercise and enables individuals with obesity to escape responsibility. For others, obesity as a disease is a bridge to additional research, coordination of effective treatment, and increased resources for weight loss.

According to Merriam Webster, a disease is “a condition . . . that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” In defining obesity specifically, one of the most comprehensive definitions is provided by the Obesity Medicine Association in the Obesity Algorithm. Obesity is defined as a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Individuals with obesity have an increased accumulation of fat not always attributable to eating too many calories or lacking physical activity. Individuals with obesity experience impaired metabolic pathways along with disordered signaling for hunger, satiety (the feeling of fullness), and fullness (the state of fullness). For many, efforts to lose weight are met with unyielding resistance or disappointing weight regain. This is demonstrated by the follow-up body composition results of contestants on “The Biggest Loser.” As contestants lose even as much as 230 pounds, their body’s response is a slower and less efficient basal metabolic rate. This occurs in an effort to return the body to its previous condition of obesity; it’s a counter-effort by the body that makes weight gain easier and weight loss harder.

The pathology of obesity is vast and varies based on the cause of weight gain. There is not just one type or cause for obesity. Obesity sub-types include congenital, stress-induced, menopause-related, and MC4R-deficient, to name a few. Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is intimately linked to heart disease, sleep apnea, and certain cancers. Obesity is one of the few diseases that can negatively influence social and interpersonal relationships.

Why obesity is a disease is becoming more evident as we increase our knowledge of fat mechanics. To successfully confront the obesity pandemic will require attacking the disease and its manifestations, not just its symptoms.

Do you consider obesity a disease? At the end of this Medscape article, you can take a short survey and view the results to find out where you stand compared to other physician specialties.

This blog article was originally written by Dr Melody Covington MD for the Obesity Medicine Association and can be found in their weight management blog section.