Ask Dr. Pat

Medical Monday: Weight Loss Medications

Despite this spotty history, we continue to search for the elixir. Plug the words “diet pills” into Amazon.com and you get over 3,500 hits, all available without a prescription. While the claims may sound promising, the advertising flashy, most are combinations of largely unproven and unregulated substances. Stay away and save your money.

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Where, then, does that leave us?  There are actually five medications currently FDA-approved for long-term obesity management. National guidelines recommend that people start with six months of exercise and improved diet. However, those with a BMI greater than 30 or greater than 27 for those with weight-related health problems (diabetes, high blood pressure, elevated cholesterol) who do not respond to these lifestyle modifications may want to consider adding a weight loss medication to their plan.   

Approved in 1999, orlistat (Xenical or Alli) has been on the market the longest and is even available in a lower-dose, over the counter form (Alli).  Newer medications include lorcaserin (Belviq), phentermine/topiramate (Qsymia), naltrexone/bupropion (Contrave), and liraglutide (Saxenda). Those last two are combinations of drugs that have been on the market for a while. In studies the paired medications, with diet and exercise, all have shown improved weight loss.  While the level of effectiveness varies somewhat between medications, for all five medications significantly more people were able to lose at least 5 percent of their body weight when compared to those taking a placebo. While 5 percent may not sound like a lot, sustaining that weight loss over a year can have positive effects on overall health.  Studies showed individuals on medication had improvement in other health measures, like blood pressure and fasting blood glucose levels, an indication of risk for diabetes. Side effects vary by medication, but include such things as headache, nausea, and dry mouth. Also, it should be noted that the naltrexone/bupropion carries a black box warning about potentially increasing suicidal thoughts, as is seen with bupropion alone.  All can lead to certain drug/drug interactions, so your physician will need to consider other medications that you are using.  It is important to work with your physician on your weight loss goals.

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I applaud you for taking steps toward a healthier life.  While we would all be wise to eat healthfully and engage in regular exercise, for some, medications that promote weight loss may be a helpful option.

Dr. Riddle

 

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“Diet pills.” Drugs and Controlled Substances: Information for Students. Ed. Stacey L. Blachford and Kristine Krapp. Detroit: Gale, 2010. Science in Context. Web. 3 Jan. 2016.

Diep, F. The Science And History Of A Pesticide-Turned-Diet Pill. Popular Science.  Jul 10, 2014.

Fetters, A. New Year’s Resolutions by the Numbers.  Details. 

Grady, D. History Counsels Caution on Diet Pills.  The New York Times. May 25, 1999.

Kumar RB, Aronne L. Efficacy comparison of medications approved for chronic weight management. Obesity (Silver Spring). 2015 Apr;23 Suppl 1:S4-7.

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