Managing obesity and reducing alcohol use are two significant and intersecting challenges for patients and healthcare professionals. Clinicians and physicians working in primary care, psychiatry, and behavioral health frequently encounter individuals who struggle with both weight-related concerns and risky drinking habits. In recent years, anti-obesity medications (AOMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combination therapies like bupropion and naltrexone, have received increasing attention for their potential not only to facilitate weight loss but also to influence other health behaviors, including alcohol consumption positively.

Emerging data from an extensive telehealth weight management program of more than 14,000 participants suggests that nearly half of the individuals who reported drinking alcohol at baseline decreased their drinking category after starting an AOM. While these findings underscore the importance of prescribing AOMs within a comprehensive clinical strategy, they also raise practical questions on how to seamlessly integrate medication management, alcohol screening, counseling, and patient education into everyday practice. We synthesize current insights to help clinicians, providers, and nurses optimally incorporate antiobesity medications into patient care, especially for individuals with overlapping weight and alcohol-use concerns—and highlight how a robust Behavioral Health EHR/EMR can streamline this process.

Recognizing the Overlap Between Obesity and Alcohol Use

Shared Behavioral Patterns

Excess weight gain and alcohol use have many shared psychosocial and behavioral underpinnings. Both eating and drinking can serve as coping mechanisms for stress, anxiety, or depression. In a clinical setting, it is critical to recognize that a patient who struggles to moderate their eating may also find it challenging to moderate alcohol intake. When a patient presents with obesity, it is worth screening for additional health behaviors, particularly alcohol use, that may contribute to poor overall health outcomes.

Metabolic and Physiological Factors

Biologically, alcohol contains “empty calories” (7 calories per gram), contributing significantly to weight gain. For instance, a single night of social drinking can add several hundred extra calories to a person’s diet. Regularly exceeding recommended limits quickly leads to weight-related issues, complicating patient management. Additionally, alcohol can interfere with metabolic processes, often exacerbating other conditions such as diabetes and hypertension, common comorbidities in patients with obesity.

Why Dual-Focus Interventions Matter

For busy clinicians, providers, and nurses, systematically addressing both weight and alcohol use may feel overwhelming. However, emerging research suggests that effectively tackling one issue, for example, weight management with AOMs, can also help reduce harmful drinking behaviors. This synergy provides holistic and efficient care that can improve short- and long-term patient outcomes.

Incorporating Research Insights Into Clinical Practice

Recent findings from a large cohort in a telehealth weight management program demonstrated that nearly half of participants who drank alcohol at baseline reduced their alcohol intake after starting an AOM. While it is not yet fully understood if the pharmacological properties of the medications, the associated lifestyle interventions, or a combination of both drove the reduction, the data provides valuable proof-of-concept for clinicians to consider. Below are some practical ways to integrate these insights into patient care.

Initiating Conversations About Alcohol Use

Many patients may feel uncomfortable discussing drinking habits unless specifically prompted. An intake form or quick screening tool (e.g., AUDIT-C or a short set of questions integrated into your Behavioral Health EHR) can help identify risky patterns early. When prescribing an AOM, consider the following steps:

1. Ask, Don’t Assume: Even casual or “social” drinkers may underestimate their consumption. Encourage honest self-reporting.

2. Normalize the Inquiry: Frame questions about alcohol use as a standard part of the weight management protocol so patients do not feel singled out or judged.

3. Use Motivational Interviewing: Explore patients’ readiness to reduce drinking in light of their weight-loss goals.

Medication Selection and Patient Education

Although the study suggests that various AOMs, including metformin, GLP-1 receptor agonists, and bupropion/naltrexone, were associated with decreased alcohol use, clinical decision-making should still be individualized:

• GLP-1 RAs (Semaglutide, Dulaglutide, etc.): These drugs may reduce cravings by attenuating the reward circuitry in the brain, potentially impacting both food and alcohol.
• Bupropion/Naltrexone: Known to suppress cravings and may be particularly helpful in patients with higher risks for alcohol misuse.
• Metformin: While primarily targeting insulin resistance, patients might reduce drinking due to broader lifestyle changes recommended in weight-management programs (e.g., caloric awareness).

When prescribing these medications, provide clear instructions on potential side effects (e.g., nausea from GLP-1 RAs, potential mood effects from bupropion) and the impact of alcohol. Discuss how specific medication side effects (like gastrointestinal discomfort) could be exacerbated by alcohol consumption, creating a natural deterrent.

Monitoring for Complications and Co-Occurring Conditions

Patients who have been using alcohol as a coping mechanism may have underlying mental health conditions such as anxiety, depression, or a history of trauma. Initiating AOMs alongside a proactive plan to reduce or eliminate alcohol can unmask these conditions if alcohol was serving as a form of self-medication. Work collaboratively with mental health professionals to ensure patients receive the necessary support, counseling, therapy, or psychiatric evaluation, especially if you see abrupt changes in drinking patterns.

Practical Strategies for Clinicians, Nurses, and Behavioral Health Providers

Adopt a Team-Based Approach

Coordinated care among dietitians, primary care providers, nurses, social workers, and behavioral health specialists can significantly improve the likelihood of patient success. For instance, nurses can perform regular alcohol screenings at follow-up visits; dietitians can address nutritional deficits that arise when patients cut out alcohol; and behavioral health counselors can help patients develop healthier coping mechanisms.

Leverage Technology and Telehealth Platforms

The large-scale data showing decreased alcohol use was generated from a telehealth weight management program. This underscores the importance of technology-driven care in:

• Expanding Access: Patients who struggle with transportation or mobility issues can still attend consistent follow-up appointments, counseling sessions, or online group discussions.
• Enhancing Continuity of Care: Telehealth platforms often include messaging systems for quick check-ins, so patients can ask questions or share concerns with their care team in real-time.
• Providing Flexible Scheduling: Evening or weekend telehealth appointments can better accommodate individuals who might miss in-person visits due to work or family responsibilities.

Address Motivational Factors and Goal-Setting

Patients who opt for antiobesity medications often do so after several unsuccessful weight-loss attempts. Harnessing their motivation for change can also encourage them to reduce alcohol use. Nurse practitioners, physician assistants, or clinical educators can facilitate goal-setting sessions that address both weight reduction (e.g., aiming for 5-10% weight loss in six months) and a decrease in weekly alcohol consumption (e.g., limiting drinks to once a week or staying below recommended guidelines).

Provide Patient Education Materials and Peer Support

Information on how alcohol intake can impede weight loss is often an “aha” moment for patients. Having easy-to-digest (no pun intended) educational resources that outline the caloric impact of alcohol can be particularly persuasive. Consider:

• Visual Aids: Charts showing the caloric content of common alcoholic beverages.
• Handouts/Infographics: Explaining how AOMs work and why alcohol can interfere with (or be impacted by) these treatments.
• Online Support Groups or Group Appointments: Virtual communities for patients who use semaglutide or bupropion/naltrexone can provide peer-to-peer support and tips for cutting back on drinking.

The Crucial Role of a Robust Behavioral Health EHR/EMR

Streamlined Data Tracking and Reporting

A well-configured and implemented Behavioral Health EHR/EMR can seamlessly capture the multiple data points relevant to patient progress:

• Medication Adherence: Track refills, prescription changes, and potential side effects.
• Alcohol Use Patterns: Integrate validated screening tools (e.g., AUDIT-C), track weekly consumption, and note any category changes over time.
• Weight and BMI Trends: Monitor progress objectively, helping clinicians quickly correlate weight loss with any reported changes in alcohol use.
• Comorbid Conditions: Keep a record of hypertension, diabetes, mental health diagnoses, and more in one place, making it easier to adopt a holistic treatment plan.

Alerts and Reminders

Modern EHRs enable automatic alerts when a patient’s documented alcohol use crosses a certain threshold or when a weight-related marker (like BMI) reaches a critical point. These alerts:

• Prompt Timely Interventions: Providers are reminded to counsel about alcohol or reevaluate medication if a patient’s reported use spikes.
• Encourage Standardized Protocols: The system can guide adherence to best practices, ensuring consistent care regardless of which clinician the patient sees.
• Support Regulatory Compliance: Many clinics must track quality measures related to alcohol screening and obesity management; a robust EHR can streamline documentation and reporting for audits.

Facilitating Multidisciplinary Communication

Effective weight management frequently spans multiple departments—primary care, nutrition, behavioral health, etc. An EHR/EMR designed for behavioral health fosters interdepartmental collaboration by granting each team member access to vital information on patient goals and progress, ensuring unified care.

Telehealth Integration

If your clinic or practice offers telehealth services, integrating these visits directly into the EHR platform ensures that all session notes, medication changes, and screening data are automatically stored in the same centralized patient record. This synergy reduces transcription errors, eliminates lost paperwork, and allows multiple providers to reference the same data set when coordinating care decisions.

Navigating Common Clinical Concerns

Polypharmacy and Interactions

When a patient already takes multiple medications for chronic conditions like hypertension, type 2 diabetes, or mental health issues, adding an AOM raises questions about drug interactions, mainly if the patient also consumes alcohol. Providers should:

• Review Current Medications: Check for known interactions, especially with bupropion (which may lower the seizure threshold) or naltrexone (which blocks opioid receptors).
• Advise Caution on Alcohol Use: Emphasize that certain drugs can have adverse interactions with alcohol, and that high intake might exacerbate side effects.
• Coordinate with Pharmacists: Pharmacists can verify medication safety and offer patient counseling.

Rapid Weight Loss and Psychological Impact

Significant weight loss, especially with potent second-generation GLP-1 RAs, may change how patients perceive themselves, their social roles, and even their relationship with alcohol. Some individuals might see improved self-esteem and spontaneously cut back on binge drinking, whereas others may struggle with new stressors. Incorporate mental health check-ins during follow-up to address evolving psychological needs.

Managing Patient Expectations

While some patients may hope for dramatic results in both weight loss and alcohol cessation, real-world progress often involves more minor, incremental improvements. Encouraging realistic goals and celebrating modest achievements can enhance treatment adherence and reduce the risk of patient frustration or dropout.

Future Directions and Considerations

Focusing on Mechanisms

The question of whether AOMs reduce alcohol use through pharmacological mechanisms, lifestyle modifications, or both remains partly unanswered. Future clinical trials comparing AOM groups to placebo or nonpharmacological weight management interventions will help clinicians clarify the extent of medication-driven effects. Understanding these mechanisms better can fine-tune medication selection and counseling approaches.

Expanding Access to Underserved Populations

Not all populations have equitable access to weight management programs or specialized medications. Telehealth holds promise for bridging some gaps, but insurance coverage, pharmacy costs, and social determinants of health (such as stable housing and food security) remain barriers. Clinicians can:

• Advocate for Policy Changes: Encourage local and national policymakers to expand coverage for AOMs and telehealth services for low-income patients.
• Partner with Community Organizations: Collaborate with social services to provide holistic support (e.g., nutrition assistance, transportation for in-person visits if needed).

Integrating Harm-Reduction Strategies

Not every patient will be prepared or able to quit drinking entirely. Adopting a harm-reduction lens can help patients gradually minimize high-risk behaviors. For example:

• Monitoring Tools: Recommend smartphone apps that log daily alcohol intake, allowing patients to see patterns over time.
• Mindful Drinking Programs: Offer online or in-person sessions that focus on moderate use rather than total abstinence for those not yet ready for complete cessation.

Summary

For clinicians, providers, and nurses on the front lines of patient care, the intersection of obesity and alcohol use poses a significant challenge, one that also presents an under-appreciated opportunity. The latest data emerging from telehealth weight management programs suggest that starting an antiobesity medication may not only drive weight loss but also nudge patients toward healthier patterns of alcohol consumption. While more research is needed to establish the precise mechanisms and long-term effects, these findings offer actionable insights for clinical practice.

By proactively screening for alcohol use, tailoring medication regimens, and providing ongoing support through telehealth and robust Behavioral Health EHR systems, healthcare teams can make meaningful strides in optimizing patient outcomes. Coordinated, multidisciplinary care that addresses both obesity and alcohol use stands to improve quality of life, reduce health risks, and promote sustainable behavior change. As antiobesity pharmacotherapy continues to evolve, so too will best practices for harnessing its benefits to tackle the dual challenges of weight management and alcohol misuse.

Effective treatment strategies require a blend of evidence-based medications, individualized counseling, and seamless data management. By integrating practical workflows into a strong EHR/EMR infrastructure, clinicians can track progress over time, identify patients needing more intensive interventions, and celebrate successes when that extra glass of wine or bottle of beer is set aside. For the growing number of individuals seeking help with both weight and alcohol use, these insights could represent a decisive turning point on their journey toward better health.