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.
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.
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.
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.
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.
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:
Ask, Don’t Assume: Even casual or “social” drinkers may underestimate their consumption. Encourage honest self-reporting.
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.
Use Motivational Interviewing: Explore patients’ readiness to reduce drinking in light of their weight-loss goals.
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:
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.
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.
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.
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:
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).
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:
A well-configured and implemented Behavioral Health EHR/EMR can seamlessly capture the multiple data points relevant to patient progress:
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:
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.
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.
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:
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.
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.
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.
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:
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:
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.