Update: Weight-Loss Drugs

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You’ve heard it so often that it’s sounding like a broken record: losing weight can help you better manage your diabetes — not to mention a host of other health conditions. And you’ve probably tried a host of diets to lose weight, with or without success.

Losing weight and keeping it off can feel like a never-ending, uphill battle. Sometimes “diet and exercise” aren’t enough. Short of having surgery, what else can you try? Medication might be an option — but before you start viewing medication as a literal “magic pill,” read on to learn more about the newest prescription weight-loss drugs available and if they might be an option for you.

Are weight-loss pills for you?

It seems so easy: visit or call your doctor and tell him or her that you’d like a prescription for X (fill in the blank) so that you can start shedding pounds. Unfortunately, it doesn’t quite work that way. Yes, weight-loss medications are available, but no, they aren’t appropriate for everyone. Here’s what your doctor needs to assess before reaching for the prescription pad:

• Risks and benefits of weight loss
• Your age
• Your current health status and other medications that you take
• Your family’s medical history
• Cost

In addition, your doctor will use your BMI, or body-mass index, to determine if you’re a candidate for weight-loss pills. Qualifying criteria based on BMI are:

• A BMI of 30.0 or more
• A BMI or 27.0 or more with other weight-related issues, such as Type 2 diabetes, high blood pressure, or sleep apnea

A BMI of 30.0 is indicative of obesity, and a BMI of 25.0–29.9 indicates overweight. If your BMI is, say, 25.0 or lower, don’t expect your doctor to prescribe these medications.

Weight-loss medications are not appropriate for pregnant or breastfeeding women, and for people who have had a recent “acute” medical event such as a heart attack or a stroke.

What can you expect with weight-loss medications?

Weight-loss meds don’t replace a healthy eating plan and physical activity. In fact, they work best as part of a holistic approach that focuses on your lifestyle: what and how much you eat, how active you are, how you’re sleeping, and how you manage stress. If you pin your hopes of achieving your weight loss goal solely on taking a medication, you will likely be disappointed and discouraged. Most weight-loss drugs are considered to be “effective” by the FDA if, after one year, at least a third of people taking them lose at least 5 percent of their body weight. So, if you weigh 200 pounds and take a weight-loss medication for a year, that med is a success if you’ve lost 10 pounds. (Of course, you might lose more than that, especially if you’ve also been working at your nutrition and physical activity.) Ten pounds can seem like a drop in the bucket, especially if you want to lose 50 or more pounds. You also need to consider that there is no guarantee that a specific medication will work for you, and when you stop taking that medication, you may gain back the weight that you’ve lost.

The good news? Losing between 5 and 10 percent of your body weight can bring about a number of improvements in your health, such as lower blood sugars and A1C, better blood pressure and blood lipids, and a lower risk for chronic conditions, including heart disease.

What are weight-loss medication options?

Most of the prescription weight-loss medications work on pathways in the brain to help curb appetite and increase feelings of fullness. Two of the medications work on the digestive tract. Here’s a rundown of the most common FDA-approved prescription weight-loss meds:

Phentermine

• Brand names: Adipex-P, Suprenza
• How it works: Decreases appetite and increases feeling of fullness
• Side effects: high blood pressure, palpitations, dizziness, dry mouth, constipation, risk of dependency
• Approved for short-term (a few weeks) use only

Phentermine and topiramate

• Brand name: Qsymia
• How it works: Decreases appetite and increases feeling of fullness
• Side effects: increased heart rate, birth defects, tingling in hands and feet, dizziness, insomnia, constipation, dry mouth, changes in taste and smell
• Avoid taking if you have glaucoma or hyperthyroidism
• Approved for long-term use
• If you don’t lose at least 3 percent of your weight after taking for 12 weeks, you may need a higher dose or your doctor may have you stop taking it

Lorcaserin

• Brand name: Belviq
• How it works: Decreases appetite and increases feeling of fullness
• Side effects: dizziness, nausea, headaches, constipation, dry mouth, cough
• May cause low blood sugar in people who have diabetes
• Can interact with certain types of antidepressant medications
• Approved for long-term use
• If you don’t lose 5 percent of your weight after 12 weeks, you may need to stop taking it as it is unlikely going to work for you

Naltrexone-bupropion

• Brand name: Contrave
• How it works: Decreases appetite and increases feeling of fullness
• Side effects: constipation, diarrhea, nausea, dry mouth, headache, high blood pressure, liver damage, insomnia, increased risk of suicidal thoughts
• Should not be used by anyone with a seizure disorder
• Approved for long-term use
• If you don’t lose 5 percent of your weight after 12 weeks, you may need to stop taking it as it is unlikely going to work for you

Orlistat

• Brand name: Xenical (Alli is a lower-dose version that is available without a prescription)
• How it works: Blocks the absorption of fat in the gut
• Side effects: gas, diarrhea, leakage of oily stools, stomach pain
• Need to take a daily multivitamin, and avoid if taking with cyclosporine
• Must follow a low-fat diet (less than 30 percent of daily calories) when taking this drug
• Approved for long-term use

Liraglutide

• Brand name: Saxenda
• How it works: Mimics a gut hormone called GLP-1 to slow gastric emptying and increase feeling of fullness
• Side effects: nausea, vomiting, abdominal pain, increased risk of pancreatitis
• Given as an injection
• The lower-dose version is Victoza, a drug used to treat Type 2 diabetes
• If you don’t lose 4 percent of your weight after taking this for 16 weeks, your doctor may tell you stop taking it

Bottom line

Prescription weight-loss medications can be helpful for many people when used along with lifestyle changes. There are a variety of options, but you need to discuss the pros and cons of each with your doctor. Also, don’t forget to check with your health plan, as not all insurance plans will cover weight-loss medications. Finally, starting any new medication may impact your blood sugars — check your blood sugars more frequently if you do start taking a weight-loss medication, and let your doctor know if you’re having a hard time keeping them within your target range.

Want to learn more about weight management? Read “Tried and True Weight-Loss Techniques,” “Strategies for Weight Management,” and “Why Can’t I Lose Weight?”

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