I always tell prospective clients that weight loss medication should NOT be the first treatment choice, and very few people need to take this class of drugs to lose weight.
Medications approved for weight loss are meant for long-term use, but they are not a quick fix (no matter what the ads say). People do lose weight on these medications; however, they should still work to build healthy eating and exercise habits into their daily lives.
How much do patients typically lose? While there can be significant differences, studies have shown that people taking obesity medications generally lose 5-10% (or more) of their starting body weight over a year. If you weigh 200 pounds, you could expect to lose 10-20 pounds if you stick with a program and your medication helps you be successful.
Some people may lose more weight, especially in the earlier months of treatment, and others may not lose much at all or could even gain a few pounds. In clinical studies, the average person maintained about half their total weight loss after four years. So, while medications can help some patients achieve significant weight loss, they are not magic bullets that will work for everyone.
What types of medications are available?
In 2012, three new prescription drugs were approved for long-term use by the FDA: Qsymia (phentermine/topiramate), Belviq (lorcaserin), and Contrave (naltrexone/bupropion).
Phentermine is a stimulant drug that has been used for decades to treat obesity. It’s only approved when used in combination with another anti-obesity medication, like topiramate. In Qsymia, it comes combined with the antihistamine topiramate. Topiramate is used to prevent seizures and migraine headaches. It can also cause side effects like fatigue, cognitive problems (forgetfulness), and difficulty concentrating.
Belviq works through a chemical pathway in your brain called serotonin 2C. This chemical helps you feel full after eating, so you don’t overeat. The most common side effects are nausea, constipation, and dry mouth.
Contrave combines an opioid blocker (naltrexone) and a stimulant drug. Naltrexone is used to treat alcohol dependence and opioid addiction. The Contrave study helped some patients lose weight but had mixed results. The most common side effects were nausea, constipation, headache, and insomnia.
Is there anything new on the horizon?
Yes! AstraZeneca, one of the world’s top 20 pharmaceutical companies, recently announced positive results from a phase 3 clinical trial for their obesity medication candidate known as AZD 2820. Two different doses of AZD 2820 tested against a placebo pill in a population of over 2200 obese or overweight patients with at least one weight-related condition such as high blood pressure or diabetes showed statistically significant weight loss. The medication works by inhibiting specific fatty acid binding sites in the intestine involved in the absorption of dietary fat. People taking the drug experienced an average weight loss of 5% or 9 pounds after 12 weeks compared to placebo pills.
How well do obesity medications work?
Patients need to see their doctor regularly. At the same time, on any weight loss medication, they can be monitored for potential side effects and learn strategies for staying successful with long-term weight control.
When appropriately used, obesity medications can help some overweight people achieve modest weight losses (5-10%) over one year. These drugs can contribute to additional weight loss not seen with diet and exercise alone as part of a comprehensive treatment program.
However, keep in mind that no available medication or combination of drugs will work for everyone. Many people don’t respond to the medicines at all, while others stop using them after a few months because they can’t tolerate the side effects. For some patients who do respond well initially, weight loss may plateau despite continued medication use.
What are the possible side effects?
All three FDA-approved prescription drugs have a black box warning stating that serious mental health events, including changes in behavior, depressed mood, or suicidal thoughts, can develop from taking these medications – particularly when used with other drugs such as antidepressants. In addition to being more prone to depression, children and teenagers who take these drugs may experience increased suicidal thoughts and behavior.
What should you look out for if you’re taking an obesity medication?
Patients need to know that these medications can cause side effects like dry mouth, constipation, insomnia, memory problems, or headaches. They also need to watch for signs of depression – changes in mood or feelings about suicide – and seek help immediately if they notice anything unusual. Also, be aware that even though some people lose weight while on these drugs, it doesn’t mean the weight will stay off forever. The best results happen when overweight people combine these medicines with diet and exercise.
Who should not take obesity medications?
People who have had a heart attack, stroke, or another severe cardiovascular event within the past 90 days should not take them. Nor should people who have uncontrolled high blood pressure, active cardiovascular disease, heart failure, or a recent history of a heart attack.
People shouldn’t take these drugs if they’re already taking narcotics for pain relief since the medications contain opioids (naltrexone) or amphetamine (Belviq and Qsymia). Finally, women who are pregnant or breastfeeding shouldn’t use them either.
If you’re thinking about trying an obesity medication to lose weight, keep in mind many alternatives available, including lifestyle changes like diet and exercise. What’s more, all three meds can cause serious side effects in some patients. So make sure to talk with your doctor before starting any medication to learn what would be best for you.
Conclusion
If you have tried diet, exercise, and other weight-loss methods without success, your doctor may recommend a prescription weight loss medication as the next step.
Prescription weight loss medications work in different ways to help promote weight loss. Some decrease an empty stomach’s ability to absorb calories from food, while others affect neurotransmitters that play a role in appetite or satiety. One of the most common types is a lipase inhibitor, which interferes with enzymes needed to digest fat.
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