Prescription weight loss. A comprehensive guide

Prescription Weight-Loss Drugs: A Comprehensive Guide

Losing weight can be a challenging journey, especially if you have tried various diet and exercise plans without success. In such cases, your healthcare provider may recommend prescription weight loss drugs as an additional tool to aid your weight loss efforts. In this article, we will explore the pros and cons of prescription weight-loss drugs, who can benefit from them, how they work, and the different medications available. It's important to note that prescription weight-loss drugs should always be used in conjunction with a healthy diet and regular exercise routine.

 

Who Can Take Weight-Loss Drugs?

Prescription weight-loss drugs are typically recommended for individuals who have been unable to lose weight through diet and exercise alone and who meet certain criteria. Generally, these criteria include having a body mass index (BMI) greater than 30, which indicates obesity, or a BMI greater than 27 with obesity-related health conditions such as diabetes or high blood pressure.

Before prescribing a weight-loss drug, your healthcare provider will consider your medical history and existing health challenges. It's essential to have an open and honest conversation with your provider about the potential benefits and risks of prescription weight-loss drugs. However, it's important to note that these drugs are not suitable for everyone. For instance, if you are trying to get pregnant, are currently pregnant, or breastfeeding, you should avoid taking prescription weight-loss drugs.

How Well Do Weight-Loss Drugs Work?

Prescription weight-loss drugs, when used for more than 12 weeks, have been shown to lead to significant weight loss compared to a placebo. In combination with lifestyle changes such as a healthy diet and exercise, these medications can result in even greater weight loss than lifestyle changes alone.

Over the course of a year, using weight-loss drugs can lead to a loss of 3% to 12% of total body weight compared to lifestyle changes alone. While this percentage may seem modest, even losing 5% to 10% of your total weight can have significant health benefits such as lowered blood pressure, improved blood sugar levels, and reduced levels of triglycerides (fats in the blood).

What You Should Know About Weight-Loss Drugs

It's important to be aware of the potential side effects and limitations of weight-loss drugs before considering them as part of your weight loss journey. While mild side effects such as nausea, constipation, and diarrhea are common, they often diminish over time. However, it's crucial to discuss all treatment options with your healthcare provider and understand the potential benefits and risks associated with each drug.

It's worth noting that weight-loss drugs can be expensive, and insurance coverage may vary. Before starting any medication, it's advisable to check with your insurance company to understand your coverage and potential out-of-pocket costs. Additionally, it's common for individuals to regain some weight after discontinuing weight-loss drugs. However, adopting healthy lifestyle habits can help minimize weight gain and maintain long-term results.

How Long Do I Take a Weight-Loss Drug?

The duration of weight-loss drug treatment depends on your individual response to the medication. If you have achieved significant weight loss, improved your health, and experienced no serious side effects, your healthcare provider may recommend long-term use of the drug.

However, if you have not lost at least 5% of your body weight after taking the full dose of a drug for 3 to 6 months, your healthcare provider may consider changing your treatment plan and switching to a different weight-loss drug.

FDA-Approved Prescription Weight-Loss Drugs

There are currently six weight-loss drugs approved by the U.S. Food and Drug Administration (FDA) for long-term use. Each medication works differently to aid weight loss, and your healthcare provider can help determine which one is most suitable for you.

1. Bupropion-naltrexone (Contrave): This combination drug includes naltrexone, used to treat alcohol and opioid addiction, and bupropion, an antidepressant and quit-smoking aid. Common side effects include nausea, headache, and constipation. Regular blood pressure checks are necessary during treatment.

2. Liraglutide (Saxenda): Originally used to manage diabetes, liraglutide is administered as a daily injection. Nausea is a common side effect, and vomiting may limit its use.

3. Orlistat (Xenical, Alli): Orlistat is available both as a prescription medication and in a reduced-strength form known as Alli, which can be purchased without a prescription. Orlistat works by affecting the way your body absorbs fat. Side effects may include passing gas, loose stools, and in rare cases, liver injury.

4. Phentermine-topiramate (Qsymia): This combination drug includes phentermine, a weight-loss drug with potential for misuse as a stimulant, and topiramate, an anticonvulsant. Possible side effects include increased heart rate, high blood pressure, insomnia, constipation, and nervousness. Topiramate also increases the risk of birth defects.

5. Semaglutide (Wegovy): Originally used to control type 2 diabetes, semaglutide is administered as a weekly injection. Side effects may include nausea, vomiting, diarrhea, belly pain, headache, and tiredness.

6. Setmelanotide (Imcivree): Setmelanotide is only approved for individuals aged 6 and older who have specific rare inherited conditions related to obesity. It helps reduce appetite and induce a feeling of fullness. Side effects may include skin irritation, patches of darker skin, nausea, diarrhea, belly pain, unwanted sexual reactions, depression, and suicidal thoughts. Setmelanotide should never be given to children under 6 years old.

It's important to consult with your healthcare provider to determine the most appropriate weight-loss drug for your specific needs and medical history.

The Bottom Line

Prescription weight-loss drugs can be a helpful tool in your weight loss journey when used in conjunction with a healthy diet and exercise. While they can lead to significant weight loss and offer health benefits, it's crucial to be aware of potential side effects and limitations. Open communication with your healthcare provider is key to understanding the pros and cons of each medication and making an informed decision about your weight loss treatment. Remember, there are no magic pills for weight loss, but with the right approach and support, you can achieve your goals and improve your overall health.

References:

1. AskMayoExpert. Weight management (adult). Mayo Clinic; 2018.
2. AskMayoExpert. Obesity (adult). Mayo Clinic; 2018.
3. Pilitsi E, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metabolism. 2019; doi:10.1016/j.metabol.2018.10.010.
4. Perreault L. Obesity in adults: Drug therapy. https://www.uptodate.com/contents/search. Accessed Oct. 12, 2020.
5. Prescription medications to treat overweight and obesity. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity. Accessed Aug. 23, 2018.
6. Melmed S, et al. Obesity. In: Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 12, 2020.
7. Patel K. Obesity treatment: A focus on pharmacotherapy of weight management. 2020; doi:10.1097/NOR.0000000000000643.
8. Papadakis MA, et al., eds. Obesity. In: Current Medical Diagnosis & Treatment 2021. 60th ed. McGraw Hill; 2021. https://accessmedicine.mhmedical.com. Accessed Oct. 21, 2020.
9. Shah M (expert opinion). Mayo Clinic. Oct. 16, 2020.
10. Apovian CM, et al. Pharmacological management of obesity: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2015; doi:10.1210/jc.2014-3415.
11. FDA Drug Safety Communication: Completed safety review of Xenical/Alli (orlistat) and severe liver injury. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-completed-safety-review-xenicalalli-orlistat-and-severe-liver-injury. Accessed Oct. 16, 2020.
12. Wegovy (prescribing information). Novo Nordisk; 2022. https://www.wegovy.com. Accessed Oct. 21, 2022.
13. Imcivree (prescribing information). Rhythm Pharmaceuticals; 2022. https://www.imcivree.com. Accessed Oct. 21, 2022.