Could Weight Loss Medication be Right for You?

Losing weight can be hard. Each year about 45 million Americans go on some form of a diet and spend billions of dollars on weight loss products. But sometimes diet and exercise aren’t enough to get the pounds off, in such cases, prescription medication may be helpful. When taken as prescribed, along with diet and exercise, one of these medications has been proven to reduce as much as 15% of body weight— about 45 pounds for a 300-pound person.

Obesity is associated with many health risks, including diabetes, high blood pressure, high cholesterol, and heart disease. The higher one's body mass index (BMI), the greater the risk of illness and death. So any additional help to reduce or manage weight should be considered. Even a weight loss of five percent– 15 pounds for someone who weighs 300 pounds– can significantly lower your risk of any obesity-related disease.

Keep in mind that weight loss medications aren’t magic. They are supportive medications to supplement—not replace—a reduced-calorie diet and regular exercise. And while there are dozens of over-the-counter (OTC) drugs with weight loss claims, they aren't approved by the FDA, so their effectiveness is unclear. In this article, we’ll focus on FDA-approved medication only. 

Who may benefit from weight-loss medication?

The people most likely to benefit from weight loss medication are those who are overweight and obese. Health care providers use your BMI to determine whether you might benefit from these medications. They might be prescribed to treat individuals with a:

●       BMI of 30 or more (obese) or

●       BMI of 27 or more (overweight), and weight-related health problems such as diabetes or high blood pressure

If you met the criteria above and haven’t met your weight loss goals (at least 5 percent of body weight in three to six months) with a reduced-calorie diet and exercise, then you may be a candidate for weight loss medication.

Once you start taking any of these medications, how long you’ll need to keep taking it depends on whether it helps you lose weight and keep it off and whether you have serious side effects.

Please note that all weight loss medication should be avoided if you are pregnant or planning to become pregnant.

What drugs are approved for weight loss?

Five weight loss medications have been approved by the FDA for long-term use:

●    Liraglutide

●    Semaglutide

●    Naltrexone/bupropion

●    Orlistat

●    Phentermine/topiramate

These medications can be expensive and aren't always covered by health insurance. The out-of-pocket costs range from around $200 to $1600 for a 30-day supply. You can ask your insurance provider about coverage to be sure.

Liraglutide (brand name Saxenda) and Semaglutide (brand name Wegovy)

Saxenda (FDA approved in 2014) and Wegovy (FDA approved in 2021), are some of the newest, most effective drugs for losing weight. Both were originally approved for diabetes management under different brand names but were also found to cause weight loss. They’re both injectable medications, but while Saxenda is injected daily, Wegovy is longer-acting so it’s injected weekly.

Naltrexone/bupropion (brand name Contrave)

Contrave was approved by the FDA in 2014. It’s a combination of two drugs: naltrexone, which is used to treat alcohol and opioid dependence, and bupropion, which is an antidepressant. It’s taken twice daily.

Orlistat (brand names Xenical, Alli)

Orlistat was FDA approved in 1999 and is available both as a prescription and OTC. The prescription form, Xenical, has a higher dose and prevents up to a third of dietary fat from being absorbed, while the OTC version, Alli, prevents a quarter of dietary fat from being absorbed. It’s taken three times daily with meals.

Phentermine/topiramate (brand name Qsymia)

Qsymia was FDA approved in 2012. It combines two different drugs: phentermine, which is an appetite suppressant approved for short-term use, and topiramate, which is used for seizures or migraines. This medication is taken once daily.

In the pipeline…

Tirzepatide (Mounjaro™) is a new drug with similar actions as Saxenda and Wegovy, but appears to yield greater results. A new study published by the New England Journal of Medicine showed that using the drug resulted in more than 20% weight loss—an average of 52 pounds per person. This medication is already FDA approved for diabetes, but not yet for weight loss.

The bottom line

Weight-loss medication isn’t an easy solution that works for everyone. However, they might help you lose weight and improve your health if used correctly. Each medicine has limitations, so speak to your health care provider to find the best option for you.

References

●      Wegovy prescribing information

●      Uptodate: Obesity in Adults

●      Prescription medications to treat overweight and obesity

●      Obesity management: update on Orlistat

●      Phentermine/Topiramate Extended-Release Capsules (Qsymia) for Weight Loss

●      Tirzepatide Once Weekly for the Treatment of Obesity