Choosing a Weight Loss Medication

 

The Problem

Obesity is a disease and has been considered one by national medical associations and institutions for over a decade now. But everything from fad diets involving cotton balls to intense prayer and fasting would suggest that it is a choice or personal failure.

Behavior does play a role. There is no doubt about that. However research has shown that there are several factors making it almost impossible for some people to drop the pounds without outside intervention. What are those interventions? Thankfully today we have less invasive and more accessible options sitting on shelves in pharmacies near you.

At Elam Health and Wellness, Dr. Stephanie Opusunju offers safe and effective weight management to help you winn the battle of the bulge. To learn more, contact the office in Dallas, Texas or request an appointment online.

 

The Solutions

There are several factors controlling appetite and metabolism. Over the years researchers have focused on creating drugs that bypass or override hormones and change the way the body processes fat.

The result? Medications that are not magic, but effective as they have helped many lose weight when nothing else worked. Medications that have been approved by the FDA, include:

 

Phentermine (Adipex, Lomaira)

How it works: Phentermine and medications like it contain a mild stimulant that is like an amphetamine. They work on chemicals in the brain to decrease appetite.

Side Effects: Due to their stimulant effects, these medications can cause an increase in blood pressure and heart rate as well as insomnia, dry mouth, anxiety and agitation. 

Things to Note: These medications are good for short term use as tolerance can develop after a few months, increased appetite may return and weight loss may plateau. These medications should not be used with certain heart conditions, uncontrolled high blood pressure, history of stroke, glaucoma (increased eye pressure), or hyperthyroid.

 

Phentermine/topiramate (Qsymia)

How it works: Qsymia is a combination of phentermine with the anti seizure/migraine drug topiramate. Qsymia has lower amounts of phentermine and topiramate than when either of these drugs are used on their own. Topiramate works synergistically with phentermine to increase feelings of fullness, make foods taste less appealing, and burn more calories.

Side Effects: The most common side effects are tingling hands and feet, dizziness, altered sense of taste, insomnia, constipation, and dry mouth. Serious side effects include certain birth defects (cleft lip and cleft palate), faster heart rate, suicidal thoughts or actions, and eye problems that could lead to permanent vision loss if not treated.

Things to note: Women of child-bearing age should get a pregnancy test before taking Qsymia, and should use birth control and get monthly pregnancy tests while on the drug. You also shouldn't take Qsymia if you have glaucoma, hyperthyroidism, heart disease, or history of stroke.

 

Bupropion HCL and Naltrexone HCL (Contrave)

How it works: Naltrexone is a medication used to treat alcohol and opioid dependency. Bupropion is used as an antidepressant and for smoking cessation. Together, they work to reduce appetite and cravings.

Side Effects: Side effects include nausea, constipation, headache, dry mouth, vomiting, anxiety and dizziness. Uncontrolled high blood pressure and a history of a seizure disorder are contraindications.

Things to note: Naltrexone blocks the opioid receptor. Therefore, use of opioid pain medications are a contraindication because it can reduce their effectiveness or precipitate withdrawal symptoms.

 

Orlistat (Alli, Xenical)

How it works: Alli is the over the counter version of orlistat and the stronger prescription version  is called Xenical. Orlistat works in a unique way by blocking your body from absorbing some of the fat you eat, making it the only anti-obesity medication that does not work by decreasing appetite.

Side effects: Oily diarrhea, fecal leakage, cramps and gas discharge that can be avoided by consuming a high-fiber and low-fat diet.

Things to note: People who take orlistat should take a daily multivitamin as there is a potential for a deficiency of some fat-soluble vitamins.

 

GLP-1 agonists (Ozempic, Saxenda, Victoza, Mounjaro, Wezgovy, Trulicity)

How they work: These are injectable medications known as glucagon-like peptide- 1 (GLP-1)  agonists. The medications are a synthetic version of a hormone that makes you feel full.  Some of these GLP-1 agonists have an astonishing average weight loss of 22.5%, far higher than any other weight loss medication and even rivaling the weight loss results of bariatric surgery. Terzepatide (Mounjaro) is a new injection medication that works on two receptors for hunger hormones GIP and GLP-1. 

Side effects: The most common side effects are gastrointestinal like nausea or vomiting and diarrhea or constipation. These medications should not be used in people with a history of pancreatitis or gastroparesis. All GLP-1 medications are contraindicated in people with a personal or family history of certain thyroid and endocrine cancers. 

Things to note: All but one of the GLP-1 agonists have to be taken by injection. They can also be very expensive. 

 

Choosing a Weight Loss Medication

If you are looking to fit into that wedding dress or kickstart a broader weight loss plan, the choice of phentermine, a short term weight loss medicaiton, is most effective. Because it contains mild stimulants, it decreases your appetite but after a period of 12-24 weeks your body does build up tolerance. 

For patients who desire long term weight loss, any of the other drugs listed above have been shown to help patients lose an average of 5-20% of their body fat in 6-12 months.

It is important to understand that all of these medications are available to those who meet criteria for obesity

Additionally, none of these medications are a magic pill. At Elam Health and Wellness Dr. Stpehanie Opusunju will be your partner in health providing you with the tools you need to change your relationship with food, nutrition and exercise so you can achieve healthy and sustained weight loss.

If you’d like to learn more about weight loss medications and permanent weight loss please feel free to call us or schedule an appointment.

Author
Stephanie Opusunju, MD Internist and Life Coach

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