Losing and maintaining weight can be challenging. While adhering to dedicated diet plans and incorporating regular exercise can significantly contribute to reaching your weight goals, there are instances where medical intervention, such as medications or surgery, becomes necessary to facilitate the journey to healthy body weight. This article delves into the latest insights on various medications available for weight loss management. We’ll explore their mechanisms of action, precautions, and potential side effects, and also shed light on the prescription process.
What Do Doctors Prescribe for Weight Loss?
Phentermine (Adipex-P)
How It Works
Phentermine, sold under the brand name Adipex-P, is a sympathomimetic amine anorectic. It works as a short-term adjunct in weight reduction by curbing appetite. Phentermine is approved for short-term use only, typically a few weeks, as a part of a comprehensive weight-reduction plan, involving exercise, behavioral modification, and caloric restriction, primarily for patients with obesity. Prolonged usage should be carefully considered due to possible risk factors associated with its class.
Side Effects
While using Phentermine, individuals may experience various side effects. These can include overstimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremors, headaches, and, in some cases, psychosis. Gastrointestinal disturbances like dry mouth, an unpleasant taste, diarrhea, or constipation are also reported.
Warnings
- Contraindicated in individuals with a history of cardiovascular diseases, drug abuse, hyperthyroidism, glaucoma, and agitation.
- Caution is advised in patients with hypertension due to potential blood pressure elevation.
- Interactions with monoamine oxidase inhibitors, alcohol, insulin, oral hypoglycemics, and adrenergic neuron-blocking medications.
- Potential withdrawal effects after prolonged high-dosage administration.
- Not recommended for pediatric use (below 16 years) or in geriatric populations (safety and efficacy not established).
- Effects on the ability to engage in potentially hazardous tasks.
- Caution in patients with renal impairment.
Phentermine-Topiramate (Qsymia)
How It Works
Phentermine-topiramate, marketed as Qsymia, combines a sympathomimetic amine (phentermine) and an antiepileptic medication (topiramate). It aids in weight management by suppressing appetite and increasing feelings of fullness.
Qsymia is approved for long-term use in weight management. Clinical trials have established its effectiveness in supporting sustained weight loss. The use should be short-term (up to 12 weeks).
Side Effects
Users of Qsymia may experience side effects such as dry mouth, insomnia, constipation, paresthesia, dizziness, and altered taste sensations. Additionally, it has been associated with an increased heart rate.
Warnings
- Contraindicated in individuals with hyperthyroidism or glaucoma.
- Caution is advised in patients with a history of cardiovascular disease or mood disorders.
- Potential for cognitive and neuropsychiatric side effects.
- Contraindicated during pregnancy.
- Contraindicated if a person is taking MAO inhibitors.
Semaglutide (Wegovy and Ozempic)
How It Works
Semaglutide, available as Wegovy and Ozempic, belongs to the class of glucagon-like peptide-1 receptor agonists. It aids in weight management by regulating appetite and slowing gastric emptying. This medication is typically prescribed as part of a comprehensive weight-reduction plan, incorporating lifestyle changes and caloric restriction.
Semaglutide is approved for long-term weight management. Its efficacy has been established in clinical trials, making it a viable option for individuals seeking sustained weight loss.
Side Effects
Users of semaglutide may encounter various side effects. These can include gastrointestinal symptoms like nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and constipation. Additionally, there may be potential adverse effects on the pancreas, such as pancreatitis.
Warnings
- Contraindicated in individuals with a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
- Caution is advised in patients with a history of pancreatitis or diabetic retinopathy.
- Potential for hypoglycemia, especially in individuals using other antidiabetic medications.
- Not recommended during pregnancy or breastfeeding.
- Contraindicated in people with hypersensitivity to semaglutide.
Liraglutide (Saxenda)
How It Works
Liraglutide, marketed as Saxenda, is a glucagon-like peptide-1 receptor agonist. It assists in weight management by regulating appetite and slowing digestion. Saxenda is generally prescribed alongside lifestyle changes and a reduced-calorie diet.
Saxenda is approved for long-term use in weight management. Clinical studies have demonstrated its effectiveness in supporting sustained weight loss.
Side Effects
Common side effects of Saxenda include nausea, vomiting, diarrhea, constipation, and abdominal pain. In some cases, users may experience hypoglycemia.
Warnings
- Contraindicated in individuals with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
- Caution is advised in patients with pancreatitis or a history of gallbladder disease.
- Potential for hypoglycemia, particularly when used with other antidiabetic medications.
- Use with caution during pregnancy or breastfeeding.
- Contraindicated in people with hypersensitivity to liraglutide.
Naltrexone-Bupropion (Contrave)
How It Works
Naltrexone-bupropion, sold under the brand Contrave, combines an opioid receptor antagonist (naltrexone) and a dopamine and norepinephrine reuptake inhibitor (bupropion). This combination helps in weight management by modulating appetite and energy balance.
Contrave is approved for long-term use in weight management. Clinical studies support its effectiveness in promoting sustained weight loss.
Side Effects
Users of Contrave may experience side effects such as nausea, constipation, headache, vomiting, dizziness, insomnia, and increased blood pressure.
Warnings
- Contraindicated in individuals with uncontrolled hypertension, seizures, or a history of opioid use disorder.
- Caution is advised in patients with a history of depression or other psychiatric disorders.
- Potential for suicidal thoughts or behaviors.
- Not recommended during pregnancy or breastfeeding.
- Should be used with caution in patients with liver disease or renal impairment.
Orlistat (Xenical)
How It Works
Orlistat, available as Xenical, is a lipase inhibitor that works in the digestive system to inhibit the absorption of dietary fats. It promotes weight loss by reducing calorie intake from fat.
Xenical is approved for long-term use in weight management. Its efficacy is supported by clinical studies, making it a viable option for sustained weight loss
Side Effects
Common side effects of Xenical include gastrointestinal symptoms such as oily spotting, flatulence, fecal urgency, headache, and abdominal pain. These are often related to its mechanism of action.
Warnings
- Contraindicated in individuals with chronic malabsorption syndrome or cholestasis.
- Caution is advised in patients with a history of kidney stones or pancreatitis, thyroid disease, diabetes, or eating disorders.
- Adequate intake of vitamins A, D, E, and K should be ensured.
Tirzepatide (Mounjaro, Zepbound)
How It Works
Tirzepatide is a dual-action solution as both a GIP receptor and GLP-1 receptor agonist. It has shown remarkable efficacy in the quest for weight loss. Adults with obesity may experience unprecedented average weight reductions of 19.5% and 20.9% with 10 mg and 15 mg doses, respectively, outshining the 3.1% reduction observed with a placebo.
Tirzepatide stands out with a majority (89% to 91%) of participants achieving a clinically meaningful 5% or more weight reduction, a threshold associated with metabolic health improvement. Impressively, higher targets of 10% or more, 15% or more, and 20% or more were reached by a significant portion of participants.
Side Effects
The safety profile of tirzepatide aligns with expectations, with transient and mostly mild-to-moderate gastrointestinal events being the most frequently reported adverse events during the dose-escalation period.
Although Mounjaro and Zepbound have the same active ingredient, their side effects slightly differ, so remember to discuss that with your healthcare provider.
Warnings
While cholecystitis was observed more frequently with tirzepatide, the overall incidence was low (≤0.6%), making causal conclusions challenging. Notably, the trial was conducted during the Covid-19 pandemic, impacting the incidence of adverse events.
Metformin (Glucophage)
How It Works
Metformin, primarily an anti-diabetic medication, flexes its muscles in the weight loss battleground. Regulating blood sugar levels, it sparks weight reduction by curbing appetite and encouraging efficient use of glucose.
While not initially designed for weight loss, Metformin has shown promise in extended weight management.
Side Effects
- Gastrointestinal allies: nausea, diarrhea, and abdominal discomfort.
- Rare, but potentially serious, is lactic acidosis.
Warnings
- Caution in renal impairment.
- Potential for vitamin B12 deficiency.
Topiramate (Topamax)
How It Works
Topiramate, a seizure and migraine medication, joins the weight loss brigade. It influences neurotransmitters, suppressing appetite and altering taste perceptions.
Although not initially crafted for weight management, Topiramate is embraced for its extended impact.
Side Effects
- Common side effects: fatigue, dizziness, and paresthesia.
- Potential for cognitive issues.
Warnings
- Caution in patients with a history of kidney stones.
- Monitoring for mood changes is required.
Zonisamide (Zonegran)
How It Works
Zonisamide, primarily an anti-seizure agent, moonlights as a weight loss supporter. It affects neurotransmitters, reducing appetite and enhancing metabolic control.
Not initially designed for the weight loss arena, its role is extending beyond its original purpose.
Side Effects
- Common side effects: drowsiness, headache, and anorexia.
- Potential for kidney stones.
Warnings
- Caution in renal impairment.
- Monitoring for signs of heatstroke is required.
Is Weight Loss Medication Safe?
Safety is a paramount concern when considering weight loss medications. While these medications can be effective for some individuals, they are not without risks. It’s crucial to note that safety depends on various factors, including the specific medication, an individual’s health history, and how well they adhere to the prescribed dosage.
Commonly prescribed weight loss medications, such as phentermine, liraglutide, and tirzepatide, have undergone rigorous testing to ensure their safety. However, like any pharmaceutical intervention, they may have side effects. For instance, phentermine, a sympathomimetic amine anorectic, can cause overstimulation, restlessness, insomnia, and gastrointestinal disturbances.
Additionally, the recently approved tirzepatide has a boxed warning about the potential risk of thyroid C-cell tumors. Individuals with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) are contraindicated from using tirzepatide. It’s crucial to communicate openly with your healthcare provider about medical history and concerns to determine the safest and most effective option.
Who Can Take Weight-Loss Medications?
Weight-loss medications are typically recommended for individuals with a body mass index (BMI) of 30 or higher, indicating obesity, or a BMI of 27 or higher with obesity-related conditions like hypertension or diabetes. The decision to prescribe these medications is based on a comprehensive evaluation of a person’s overall health, medical history, and weight loss goals.
Generally, candidates for weight-loss medications should be committed to lifestyle changes, including a balanced diet and regular exercise. Those with certain health conditions, such as cardiovascular issues or a history of drug abuse, may not be suitable candidates. Pregnant or nursing individuals and those with specific contraindications to the prescribed medication are also advised against using weight-loss medications.
Before starting any weight loss medication, a thorough consultation with a healthcare provider is essential to assess individual suitability and discuss potential risks and benefits.
12 Things to Know About Weight-Loss Medications
- Not magic pills, but support tools: Weight-loss medications are not miraculous solutions; they function as supportive tools in conjunction with lifestyle changes, including a balanced diet and regular physical activity.
- Effectiveness with lifestyle changes: These medications achieve optimal results when combined with healthy lifestyle choices. Incorporating a nutritious diet and regular exercise enhances their efficacy in promoting weight loss. Healthcare providers play a pivotal role in motivating patients to sustain these positive lifestyle changes beyond the medication course for enduring well-being.
- Awareness of potential side effects: Understanding the potential side effects associated with weight-loss medications is crucial. For instance, liraglutide, a GLP-1 receptor agonist, may induce gastrointestinal issues such as nausea and diarrhea. Being informed empowers individuals to recognize and manage these effects effectively.
- Risk-benefit assessment: The decision to use weight-loss medications involves a careful risk-benefit assessment. Healthcare providers and patients collaboratively weigh the potential benefits of weight loss against the risks associated with the specific medication, considering individual health conditions and preferences.
- Realistic expectations: Weight loss medications can facilitate the shedding of excess weight, but sustained success requires ongoing lifestyle changes. Realistic expectations should acknowledge that these medications are typically prescribed for short-term use. Individuals should be prepared to transition to a maintenance plan once the initial medication course is completed.
- Short-term use, transition to maintenance: Weight-loss medications are generally prescribed for short-term use. Individuals should anticipate transitioning to a maintenance plan upon completing the initial prescribed course. This transition phase involves consolidating progress and adapting to a sustainable, long-term approach to weight management.
- Regular follow-up with healthcare provider: Continuous monitoring and support are essential during the course of taking weight loss medication. Regular follow-up appointments with a healthcare provider allow for the monitoring of weight management dynamics, addressing any emerging concerns, and making necessary adjustments to the treatment plan.
- Individualized treatment plans: Recognizing that each individual’s response to weight-loss medications can vary, healthcare providers tailor treatment plans to the specific needs and circumstances of the patient. Customization ensures that the chosen medication aligns with the individual’s health goals and potential risks brought on by the prescribed medicine.
- Education and empowerment: Providing patients with comprehensive education about the prescribed medication fosters empowerment. Informed individuals are better equipped to actively participate in their weight management journey, making lifestyle choices that complement the pharmacological intervention.
- Addressing psychological aspects: Weight loss is not solely a physical process; it involves psychological and emotional aspects. Healthcare providers should address these dimensions during follow-up appointments, ensuring that patients receive comprehensive support for their overall well-being.
- Integration with behavioral strategies: Effective weight management involves not only the biochemical effects of medications but also behavioral strategies. Integrating cognitive-behavioral approaches into the overall treatment plan enhances the sustainability of weight loss and promotes lasting positive habits.
- Flexibility in treatment approaches: Recognizing the evolving nature of a patient’s weight management journey, treatment plans should be flexible. Adjustments may be necessary based on individual responses, changing health conditions, or emerging medical insights.
Incorporating these key aspects into the understanding of weight-loss medications empowers individuals to embark on a comprehensive and sustainable journey toward achieving and maintaining a healthier weight.
How to Receive a Prescription for Weight Loss Medication
Obtaining weight loss medication involves a structured process to ensure safety and efficacy. The journey typically begins with a visit to a healthcare provider, such as a primary care physician, a specialist in obesity medicine, or other medical professional. During this consultation, the healthcare provider conducts a thorough assessment, considering factors like medical history, current health status, and weight loss goals.
If deemed suitable, the healthcare provider may prescribe a specific weight loss medication, tailoring the choice to the individual’s needs and potential risks. Prescription medications like phentermine, liraglutide, or tirzepatide are not available over the counter and require a doctor’s authorization.
Pharmacy regulations vary, but generally, individuals can fill their prescriptions at a local pharmacy. It’s crucial to follow the prescribed dosage and attend scheduled follow-up appointments to monitor progress and address any concerns.
For those considering weight loss surgery or other more intensive interventions, specialized consultations with bariatric surgeons or relevant healthcare professionals may be necessary. Surgical interventions are typically reserved for individuals with severe obesity or obesity-related health complications.
In Conclusion
Weight loss medications can be a valuable tool in the journey toward a healthier weight. Their use should be approached with careful consideration under professional guidance, emphasizing the holistic nature of weight management. Ultimately, the goal is not just shedding pounds but fostering sustainable habits that promote overall well-being. Always consult with your healthcare provider to tailor a weight loss strategy that aligns with your individual needs and health goals.
FAQ
What is the most effective weight loss medication?
What are the new prescription medications for weight loss?
Tirzepatide, a GIP receptor and GLP-1 receptor agonist, stands out as a recent addition to weight loss medications, gaining approval in 2022.
