Are weight loss medications appropriate for everyone?  The short answer is NO.  A number of things must be taken into consideration before starting a weight loss medication.  These include past and current medical history, family history, likely health benefits of weight loss, medication side effects/interactions, and medication cost.

Typically diet medications are aimed at individuals with a BMI of at least 30 or a BMI as low as 27 with weight related medical issues, and generally work best for individuals needing to lose 50lbs or less.  While those looking for a loss greater than 50lbs may lose weight using diet medications, it is less realistic they will be able to lose to a healthy BMI of 25 or lower.  Medications combined with lifestyle and exercise changes generally result in a loss between 3-10% of starting body weight.  However, results vary dependent on the individual and the medication.  Post bariatric surgery patients that re gain weight may also find diet medications helpful for getting back on track.  However, medications are not recommended for patients who are less than 1 year post bariatric surgery (excluding gastric balloon patients that may start medications when balloon is removed at 6 month).

Most diet medications are taken on a daily basis (with some exceptions) and are intended for short term use however, time may be extended dependent on the individual success.  Additionally, some diet medications can be quite expensive and may not be covered by insurance. Current prescription medications must be considered as some diet medications can adversely interact with other prescription medications.  Also, some diet medications can exacerbate certain medical conditions.  What works for one may not work for another.

Finally, diet medications aren’t magic and don’t work alone.  Changes in eating and exercise habits are necessary for the individual to have and sustain successful weight loss.  The goal is to change unhealthy eating and exercise habits to healthy ones while on the medication, and to maintain those changes once the medication is discontinued.   Also, it is not unusual to re gain some of the weight after discontinuing the medication.  Best success comes with continued healthy eating habits and regular exercise.  It is recommended you do at least 150 minutes of moderate-intensity aerobics along with 2 days of muscle strengthening.  That means to maintain your weight loss after discontinuing diet medications you may need to do more than 300 minutes of moderate-intensity exercise weekly.

Below is a list of some of the more commonly prescribed medications and their potential side effects.  As you can see diet medications work in various ways.  Some curb appetite while others effect fat absorption.  All have potential side effects and drug interactions.

 

MedicationHow it worksCommon side effectsWarnings
Orilast NIH ex(Xenical)reduces fat absorptionDiarrhea, gas, leakage of oily stools, stomach painRare cases of severe liver injury
Phentermine

benzphetamine

diethylpropion

phendimetrazine

Lessens appetite

 

Short term use

Constipation, dizziness, dry mouth, taste change, trouble sleeping, Heart palpitations, jittery, raised blood pressureContraindicated if pregnant or breast feeding, have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma. Watch if have severe anxiety or other mental health problems
H exter(Qsymia) Phentermine/Topiramatelessens appetite, and makes you feel full soonerConstipation, dizziness, dry mouth, taste changes, especially with carbonated beverages, tingling of your hands and feet, trouble sleepingDon’t use if you have glaucoma or hyperthyroidism.

 

Do not use if pregnant or planning to get pregnant or are breast feeding.

link(Contrave)

Naltrexone/buproprion

May make you feel less hungry or full soonerConstipation, diarrhea, dizziness, dry mouth, headache, increased blood pressure, increased heart rate, insomnia, ,liver damage, nausea, vomitingDo not use if you have uncontrolled high blood pressure, seizures or a history of anorexia/bulimia nervosa, dependent on Opiod pain medications, or going through alcohol withdrawal.  Do not use if already taking Wellbutrin, Zyban.

MAY INCREASE SUICIDAL THOUGHTS OR ACTIONS.

(Saxenda)

Liraglutide

Available by injection only

 

(cost prohibitive except with certain insurances)

May make you feel less hungry or full soonerNausea, diarrhea, constipation, abdominal pain, headache, raised pulseMay increase the chance of developing pancreatitis.  Has been found to cause a rare type of thyroid tumor in animals.

 

As you can see, not everyone is a good candidate for diet medications.  As always, never take a prescription diet medication that wasn’t prescribed specifically for you.  As indicated in the chart above the results may unexpected and can potentially be very harmful.