By Kaci Oliver, MS, RD, LDN
Have you had an endless struggle with your weight, and feel as though you have tried every diet in the books? Chronic dieting can seem like an endless, frustrating cycle often leading to people seeking out weight loss medications to help with their weight loss journey. But with all of the options out there, which one is the best choice for you?
Today, I am going to break down all of the different weight loss medication choices out there so you can make the best, informed choice for you.
Who may benefit from weight loss medications:
Weight loss medications are for people who are obese or overweight, and have tried healthy lifestyle changes without success. To qualify for weight loss medications, you must have a body mass index (BMI) ≥30 OR a BMI ≥ 27 with an obesity related comorbidity such as hypertension, hyperlipidemia, or diabetes.
Weight loss medications:
- Adipex (phentermine):
- Mechanism of action: stimulates the central nervous system (nerves and brain), which increases your heart rate and blood pressure and decreases your appetite.
- Benefits: suppresses appetite, inexpensive, increases energy.
- Limitations: FDA approved for short-term (12 weeks) use only. Not indicated in adults at risk of heart disease, or history of glaucoma, anxiety and hyperthyroidism. Do not use if pregnant. Cannot use medication if you have used an MAO inhibitor in the past 14 days. It is a controlled substance and has potential for dependance.
- Side Effects: dry mouth, constipation, trouble sleeping, feeling restless, anxiety, dizziness, headache, high blood pressure, increased heart rate.
- Wegovy (simaglutide):
- Mechanism of action: GLP-1 receptor agonist works to slow down digestion to improve satiety, and in areas of the brain to reduce cravings and appetite.
- Benefits: approved for long term use, only requires 1x/week injection, can reduce risk of CVD and CKD, helps regulate blood sugar. Average 5-15% long-term weight loss seen in patients taking Wegovy.
- Limitations: Expensive, hard to get insurance coverage, requires injection. Not indicated in adults with history of thyroid disease or Multiple Endocrine Neoplasia syndrome type 2. May increase risk of pancreatitis.
- Side Effects: nausea, diarrhea, constipation, vomiting, abdominal pain, headache, fatigue.
- Saxenda (liraglutide):
- Mechanism of action: GLP-1 receptor agonist works to slow down digestion to improve satiety, and in areas of the brain to reduce cravings and appetite.
- Benefits: approved for adults and children, approved for long term use, helps regulate blood sugar; can reduce risk of CVD and CKD. Average 5-20% long-term weight loss seen in patients taking Saxenda.
- Limitations: expensive, requires daily injection. May increase risk of pancreatitis. It is not indicated in adults with history of thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2.
- Side effects: nausea, diarrhea, constipation, vomiting, abdominal pain, headache, and increased heart rate.
- Contrave:
- Mechanism of action: combination medicine of naltrexone, which is used to treat alcohol and drug dependence, and bupropion (Wellbutrin), which is used to treat depression or help people quit smoking. It works in the areas of the brain to reduce cravings and hunger.
- Benefits: not a controlled substance or stimulant, daily pill. Patient’s taking contrive lost 2-4x more weight loss than those with dieting and exercising alone.
- Limitations: not for adults with history of high blood pressure, eating disorders, depression or seizures. Not indicated in adults who are dependent on opioid medications or withdrawing from drugs and alcohol. May increase suicidal thoughts.
- Side effects: constipation, diarrhea, dizziness, dry mouth, headache, HTN, increased heart rate, insomnia, liver damage, nausea, and vomiting.
- Orlistat:
- Mechanism of action: Works in your gut to reduce the amount of fat your body absorbs from the food you eat.
- Benefits: available for adults and children older than 12 years old.
- Limitations: Requires three doses a day (one pill with every meal). Can cause liver damage and nutrient deficiencies of fat-soluble vitamins. Dietary fat should be limited to 30% of less of your daily intake to reduce negative side effects.
- Side effects: diarrhea, gas, leakage of oily stools, and stomach pain.
- Qsymia:
- Mechanism of action: a combination medicine of phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. Works in areas of your brain to suppress appetite and increase satiety.
- Benefits: for adults and children, may get 70% covered by insurance company, 24-32 pounds average weight loss, reduces cravings
- Limitations: not indicated in those with hyperthyroidism or glaucoma. Not indicated for women who are pregnant (may cause birth defects) or breastfeeding. May increase suicidal thoughts in those with history of depression. Controlled substance.
- Side Effects: dizziness, constipation, dry mouth, taste changes (especially with carbonated beverages, tingling of hands and feet, insomnia, increased heart rate, suicidal thoughts.
Conclusion:
Taking a weight loss medication is a personal choice, and has been shown in research to assist with weight management along with diet and exercise. All weight loss medications come with benefits and negative side effects. It is critical to discuss which weight loss medication is best for you with your doctor.
Call our office today at 336-610-1300 to schedule an appointment with one of our providers if you are interested in starting a weight loss medication.
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