Having difficulty losing weight with diet and exercise alone?
11/16/2020 by Ramona DeJesus, M.D.
There are times when diet and exercise are not enough to achieve weight loss, and additional help in the form of medicines and surgery is needed. Here are some facts to know when thinking of weight-loss medications:
Who should take well-loss medications?
Your body mass index (BMI), which is a measure of your weight relative to your height, is used 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 (FDA) has approved the use of weight-loss medications in adults who:
- Have a BMI of 30 or greater.
- Have a BMI between 27 and 29.9, and have medical problems, such as diabetes, heart disease or high blood pressure.
The first step in deciding if a weight-loss medication is right for you is to review your blood work and medical history with your health care provider. Remember that although medications can help achieve success with weight loss, they also can be harmful and lead to serious side effects if not prescribed appropriately. They also do not replace diet and exercise.
How do weight-loss medications work?
Weight-loss medications work by reducing your appetite or changing the way you digest food. They help achieve a better hormonal balance between the stomach and the brain to change the way your body and mind respond to food.
How do I pick the right medication?
There is no one best option. It is more about finding one that fits your lifestyle and health profile. You may have other health conditions that may benefit from a certain medication. The goal is to lose at least of 5% to 10% of your starting body weight, which will significantly improve overall health.
How long do I take weight-loss medications?
Most weight loss typically takes place within six months of starting weight-loss medications. Some achieve success around this time, while others don't. It is important to closely follow up with your health care provider often, 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 health care provider may recommend that you stop taking it.
What are the available medicines for weight loss?
Weight-loss medications are no magic pill, but if used in the right setting, they may help you lead a healthier life. Pregnant women should never take weight-loss medications. Women who are planning to get pregnant also should avoid these medications, as some may harm a fetus.
These medications have been approved by FDA for weight loss, and all are indicated only for adults, except Orlistat, which is also approved for children 12 years and up:
- Liraglutide (Saxenda)
This medication, which is used to treat diabetes, also can be used for weight loss. It may make you feel less hungry or full sooner. It is available as injection only. Side effects include constipation or diarrhea, nausea, abdominal pain and rapid heart rate. It also may increase the chances of developing pancreatitis.
- Lorcaserin (Belviq)
This weight-loss medication was widely used, but it was withdrawn from the U.S. market in early 2020 due to concerns over the possibility of increased cancer rates.
- Orlistat (Xenical)
This medication works by reducing the amount of fat your body absorbs from the foods you eat. A lower-dose version, Alli, is available without a prescription in many countries, including the U.S. Common side effects include diarrhea, oily stools, gas and stomach cramps.
- Naltrexone-bupropion (Contrave)
This medication is a mix of naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking. This medication makes you feel less hungry or full sooner. Side effects are constipation, diarrhea, dizziness, dry mouth, headache, increased blood pressure, increased heart rate, insomnia and liver damage. It should not be used if one has uncontrolled high blood pressure, has a history of seizure or eating disorder, or is dependent on opioid pain medication.
- Phentermine (Lomaira)
This is the most widely prescribed weight-loss medication in the U.S. This medication, which curbs your appetite, is FDA-approved for short-term use only ― up to 12 weeks. Side effects include increased heart rate and blood pressure, insomnia, constipation, dry mouth and nervousness.
- Phentermine/topiramate (Qsymia)
This medication is a mix of phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. This medication works by making you less hungry or feel full sooner. Side effects include racing heartbeat, constipation, dry mouth, dizziness, trouble sleeping, tingling and a sudden decrease in vision.
It is important to understand the risks, benefits and limitations of these medicines. Side effects may be bothersome, long-term safety data are limited, and they can be expensive. Be sure to consult your primary care provider before starting any weight-loss medication.
Dr. Ramona DeJesus, is a general internist in Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM). She completed her medical degree at the University of Florida and completed her residency in internal medicine at Mayo Clinic in Rochester. She is board-certified in internal and obesity medicine. Her interests include chronic disease management in primary care and population health management of high-risk patients.