It’s all over the news: People who have long struggled with obesity are turning to prescription medications to help them control their appetite and melt away the pounds, often creating shortages for those who use the drugs for other conditions. Still, anyone considering weight-loss medications should understand the basics of how they work as well as the pros and cons.
About two-thirds of Americans are overweight or obese, according to the Centers for Disease Control and Prevention (CDC). And the obesity rate has climbed steadily over the past several decades, with 40% of Americans now classified as obese, having a body mass index (BMI) of 30 or higher.
Weight-loss medications are meant to help those who are overweight or obese, especially if they have related health problems such as diabetes, high blood pressure or high cholesterol. But it’s also important that they’ve first attempted to lose weight through lifestyle behaviors such as physical activity and eating healthy foods.
Medications can’t replace exercise or diet measures as ways to lose weight. Research demonstrates that weight-management drugs work best when combined with all the other things people should do to take care of their health, regardless of size.
About a half-dozen weight-loss medications have been approved by the U.S. Food and Drug Administration (FDA) for use in adults and, in some cases, children as young as 12. What are they and how do they work?
One class of medications works by mimicking a gut hormone called GLP-1 that provokes insulin production, decreasing appetite and making people feel full. The medication comes in two different formulations. Semaglutide (Wegovy or Ozempic) is a weekly injection, while liraglutide (Saxenda) is a daily injection. These medications were originally approved as treatments for type 2 diabetes, and those drugs are sometimes prescribed off-label for people with obesity.
Tirzepatide (Mounjaro), also an injectable, is a medication that mimics two gut hormones, GLP-1 as well as a glucose-dependent insulinotropic polypeptide (GIP) – increasing insulin secretion, decreasing inappropriate glucagon secretion and slowing gastric emptying.
Xenical (orlistat) blocks the body from absorbing about one-third of the fat that’s eaten. Taken as a capsule, it’s also sold without a prescription – at half Xenical’s dose – as a brand called Alli.
Contrave (naltrexone HCl and bupropion) combines two other drugs in a pill that targets areas of the brain involved in hunger and cravings.
Adipex or Suprenza (phentermine) belongs to a class of drugs called appetite suppressants, which help people eat less. Use these with caution as they can have significant cardiac side effects.
Risks and rewards
Some of these medications are meant to be used for short periods; others, longer. All come with side effects that vary widely – ranging from headache, nausea, vomiting, diarrhea, constipation and dizziness to dry mouth, insomnia and heart palpitations. Serious side effects can also occur, including pancreatitis, gallbladder disease, kidney problems and hypertension.
Nobody should take a weight-loss medication thinking that it’s free of possible complications. It’s a decision that can have serious consequences for the body.
That said, weight-loss medications can offer significant benefits, which is what most people focus on. When combined with healthy eating and physical activity, many people taking them can lose 10% or more of their body weight.
The health benefits can be incredible, lowering people’s blood sugar, cholesterol and blood pressure levels. Significant weight loss can also help ease joint pain and improve or eliminate sleep apnea symptoms, really improving someone’s overall quality of life.
Those interested in taking prescription weight-loss drugs should speak to their doctor about the risks and benefits. This is not a decision to take lightly, but for the right person, these medications can be a game-changer.
Denise Pate, M.D., is a board-certified internal medicine specialist and medical director of
Medical Offices of Manhattan, which offers comprehensive health care at four locations in New York City. For more, visit medicalofficesofmanhattan.com.