Prescription Weight-Loss Drugs: When, Who, How?

By: 
Anisha Gupta, MD

When we talk about medically supervised weight loss, there are several factors to consider. A healthy change to your diet and exercise regimen can make a world of difference for your weight, but a lot of times these changes are not possible without some additional help. Let’s discuss one option in particular: Prescription weight loss medications. For this option, it’s necessary to explore three things Who, When and How?

First, the Who, as in who should consider weight loss medications. Health care providers use your body mass index (BMI), which is a measure of your weight relative to your height, to define overweight and obesity. Adults with a BMI between 25 and 30 are considered overweight and those with a BMI of 30 or greater are considered obese. The Food and Drug Administration has approved the use of prescription weight loss medications in all patients with a body mass index (BMI) over 30 or any patient with a BMI of 27 who also has other chronic conditions such as diabetes, high blood pressure or high cholesterol. If lifestyle changes such as healthy eating and regular physical activity are not enough to help you lose weight and maintain your weight loss, your doctor may prescribe weight loss medications. The first step in deciding if a weight loss medication is right for you is to review your bloodwork and medical history with a certified healthcare provider. In addition, your doctor will have to consider the likely benefits of weight loss, possible side effects, other medications you take, your family history and cost. If you are pregnant or are planning a pregnancy, avoid taking weight-loss medications. Remember that even though medications can help you achieve success with weight loss, they can also be harmful and lead to serious side effects, so checking with a specialist first is KEY!

Now, to the When: Diet and exercise are the foundation of any successful weight loss program, but it is not always easy to make changes. If you are finding that no diet or exercise plans are working for you, adding on a weight loss medication might allow you to achieve a better hormonal balance between the stomach and the brain to help change the way your body and mind respond to food. However, it is important to understand that medications don’t replace physical activity or health eating habits as a way to lose weight, but rather should be used in conjunction. Next up and, maybe most importantly, is the How: When it comes to picking which medication is right for you, there is no ONE BEST option. There are several drugs on the market that have great success; it’s more about finding the one that fits your lifestyle and health profile. Do you prefer a pill or an injection? Do you have other conditions that may benefit from a certain medication? Do you suffer more from hunger or cravings for carbohydrates? These are some of the questions that need to be answered to determine which regimen is right for you! Your doctor may prescribe several different weight loss medications, either in combination or individually, to find the most appropriate regimen for you. Weight loss of 5-10% of your starting body weight may lead to significant improvements in your health.

And finally, let’s talk timeline: How long can you use these medications? The answer is case-based. Most weight loss typically takes place within six months of starting these medications. Some patients have success coming off weight loss medications with time (usually 6 months or longer) and several others try to stop but then restart the medication because they regained their weight. Allowing for unchecked weight regain can lead to resistance to further weight loss efforts in the future. The best way to tackle this situation is to follow up with your healthcare provider frequently, especially when you hit roadblocks. As a rule of thumb, if you do not lose at least 5% of your starting weight after 12 weeks on the full dose of your medication, it is possible that your doctor may advise you to stop taking it.

In the end, if you find the right healthcare professional who can provide a safe, balanced and empathetic approach to weight loss—trust them and trust the process. Weight loss medications are no “magic pill” and they are not for everyone with a high BMI, but in the right setting, they may help you lead a healthier life.

Weight-loss medication Approved for How it works Common side effects
Orlistat (Xenical) Adults and children 12 years or older Decreases the amount of fat your body absorbs from food; recommended with a daily multivitamin Diarrhea, oily stool, gas, stomach ache
Phentermine-topiramate (Qsymia) Adults Decreases your appetite and may make you feel full sooner Racing heartbeat, constipation, dry mouth, dizziness, trouble sleeping, tingling, sudden decrease in vision
Naltrexone-bupropion (Contrave) Adults May make you feel less hungry or full sooner Constipation or diarrhea, vomiting, dizziness, headache, increased heart rate and/or blood pressure, liver damage, may increase suicidal thoughts or actions
Liraglutide (Saxenda) – injection only Adults May make you feel less hungry or full sooner. At a lower dose with the name Victoza it’s used to treat type 2 diabetes mellitus Constipation or diarrhea, nausea, abdominal pain, headache, increased heart rate, may increase risk of pancreatitis
Other medications that can decrease your appetite include phentermine, benzphentamine, diethylpropion, phendimetrazine Adults; only short-term use (12 weeks) Increase chemicals in your brain to make you feel less hungry or full sooner High blood pressure, increased heart rate, anxiety, restlessness, dizziness, decreased vision, dry mouth

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