When a patient’s plan calls for more than just calorie-controlled diet, behavior modification and an increase in physical activity, the next tool that can be used to achieve weight-loss and health improvement is medication. Medical Weight Management may offer prescriptions to individuals affected by obesity who have failed to achieve weight-loss through diet and exercise alone.
Note: None of the obesity medications discussed below should be taken while pregnant or attempting to become pregnant. One medication, Qsymia®, has specific FDA warning label information around the use of birth control due as to a birth defect risk. If you have any questions regarding these medications, please contact a healthcare provider.
Currently there are several medications that are approved by the FDA for weight-loss:
Phentermine is a medication available by prescription that works on chemicals in the brain to decrease your appetite. It also has a mild stimulant component that adds extra energy. Phentermine is a pill that is taken once a day in the morning time. Tolerance to this medication can develop, so it is often used for only several months at a time. Common side effects are dry mouth and sleeplessness. The average weight-loss is 4-5 percent of your weight after one-year. In a 200 pound person, this means about 10 pounds of weight-loss.
The medication alli® is a lower potency of the prescription drug Xenical® (orlistat). It is the only FDA-approved weight-loss medication that is available over-the-counter and available at a higher dose with a prescription. It is a capsule that is usually taken three times per day before a meal that contains dietary fat. It works by decreasing the amount of fat your body absorbs. This means that only 2/3 of the calories that you take in from fat will be absorbed. The other 1/3 of the calories gets carried away in the digestion tract as stool. The company that makes this drug (GlaxoSmithKline Consumer Healthcare) also offers a Web site with education and support tools for users at www.myalli.com.
The average weight-loss is about 5 percent of your weight after one year. In a person who weighs 200 pounds, this would mean 10 pounds of weight-loss.
Lorcaserin HCI was approved in June 2012 by the FDA and became commercially available in June 2013. It works by helping you feel full while eating less, and it works on the chemicals in your brain to help decrease your appetite.
In individuals who took the medication for one-year, it has been shown to have an average of 7 percent weight-loss. In a 200 pound person, this would mean a 14 pound weight-loss. Blood sugar, cholesterol and blood pressure levels have also been shown to improve.
CONTRAVE®, approved in 2014 by the FDA, is a combination of two medications that have been approved for other medical problems. Naltrexone is a medication used for the treatment of narcotic and alcohol dependency. Bupropion is used as an antidepressant and for helping people stop smoking. When used in combination, these two medications work together in the brain to decrease appetite and control eating.
Among individuals who took the medication for one year, 65 percent of the study subjects lost at least 5 percent of their body weight. In a 200 pound person, this would mean a 10 pound weight-loss. Also, 39 percent lost at least 10 percent of their body weight. In a 200 pound person, this would mean a 20 pound weight-loss. Improvements in bad cholesterol, triglycerides and good cholesterol were also seen.
This combination medication was approved by the FDA in July 2012. Topiramate is a medication used in migraine prevention as well as seizure prophylaxis. It was found that a common side effect of this medication was weight-loss. Phentermine, as described in this brochure, helps to increase your energy and decrease your appetite.
Among individuals who took the highest does of Qsymia® (15 mg phentermine and 92 mg of topiramate ER) for one-year, they achieved an average of 14.4 percent weight-loss. In a 200 pound person, a 14.4 percent weight-loss would mean a loss of 29 pounds. Cholesterol levels have also been shown to improve.
Liraglutide, approved in 2014 by the FDA, is an injectable medication that increases our natural production of insulin, which is needed to regulate the levels of sugar in the blood. It decreases the production of a hormone that opposes insulin called glucagon. It also slows down the emptying of the stomach. Lastly, it works in the brain to reduce the amount of food consumed. As such, it has been used for the management of diabetes for the last few years.
In four trials consisting of more than 5,000 individuals, participants received 3mg of liraglutide daily. The outcomes showed that among individuals who took the medication for one year, 73 percent of the study subjects lost at least 5 percent of their body weight. In a 200 pound person, this would mean a 10 pound weight-loss. Also, 41 percent lost at least 10 percent of their body weight. In a 200 pound person, this would mean a 20 pound weight-loss.