Being overweight and obese has long been a significant health concern, with millions of people worldwide striving to achieve and maintain a healthy body weight. The prevalence of overweight and obesity have both risen significantly and it is estimated that 50% of Americans will meet the criteria for obesity (body mass index over 30) by the year 2030. While optimizing nutrition and increasing physical activity remain essential components to any successful weight loss journey, some individuals may need additional support in the form of medication in order to achieve their weight loss goals. Afterall, losing weight is far more complicated than ‘eat less, exercise more.’ It’s important that people recognize this. Even many healthcare providers don’t understand what drives overweight and obesity, which are very complicated medical disease states. Anti-obesity medications (weight loss medicines) are another tool which can help patients achieve their goals. It’s important to focus on scientific, evidence based, research proven medications. In this blog post, Seger | MD will delve into the science behind medical weight loss, exploring how these treatments work, their safety, and their potential benefits.

Understanding Medical Weight Loss

The use of medications in weight management is very common and widely supported by leading obesity medicine and weight loss experts. Prescription medications to aid in weight loss are gaining in popularity and acceptance and for good reasons—they work. That doesn’t mean everyone needs to be on a weight loss medication to be successful, but certainly it is a valid tool to consider when other prescribed nutrition and lifestyle approaches are not working. These medications are typically recommended for people classified as overweight (BMI over 27 w/ at least one weight-related illness) or obesity (BMI over 30) 

The Science of Medical Weight Loss

Anti-obesity medications (weight loss medications) work through various mechanisms to aid in weight reduction. Here are some common ways in which these medications operate.

• Appetite Suppression: Many weight loss medications target the appetite control centers in the brain, helping individuals feel full on smaller meals. By reducing hunger and cravings, these drugs can lead to decreased calorie intake and, consequently, weight loss.
• Reduced Fat Absorption: One medication, Orlistat, works by decreasing the absorption of dietary fats in the digestive system. By limiting the number of calories absorbed from fats, these medications can contribute to weight loss.
• Enhanced Satiety Hormones: Some medications influence the release of gut hormones which regulate hunger and fullness. This can help individuals achieve a sense of satiety earlier on in a meal and delay the emptying of the stomach into the small intestine, both of which can produce a decrease in appetite.
• Decreased Emotional Eating: Some medications target the emotional factors that lead to overeating. By affecting neurotransmitters related to mood and stress, they can reduce emotional eating behaviors.

Commonly Prescribed Weight Loss Medications

Several weight loss medications have been approved by the FDA (Food and Drug Administration) They are as follows.

• Orlistat (Alli, Xenical): Orlistat is a lipase inhibitor that reduces the absorption of dietary fat. It is available over the counter as Alli and as a prescription medication called Xenical.
• Phentermine-Approved in 1959, is the oldest FDA approved medication for weight loss. It is a mild sympathomimetic (stimulant) medication (much milder than medications traditionally used for the treatment of ADHD). It reduces appetite by acting on a brain neurotransmitter called Norepinephrine. 
• Phentermine/Topiramate (Qsymia): This combination medication has a dual acting effect on appetite by impacting 2 different neurotransmitters (chemicals) in the brain. 
• Buproprion-Naltrexone (Contrave): Combining bupropion (an antidepressant/anti-anxiety medication) and naltrexone (used to treat addiction), this medication targets neurotransmitters in the brain which decrease overall appetite and cravings. 
• Liraglutide (Saxenda): Originally developed as a diabetes medication, liraglutide mimics a gut hormone called Glucagon like peptide (GLP)-1 which signals the brain that the person has eaten. This leads to earlier satiety in a meal and the sense of fullness can persist for longer due to delayed stomach emptying into the small intestine.
• Semaglutide (Wegovy) – There are multiple names for semaglutide but only Wegovy is FDA approved for weight loss. Similar to Liraglutide, it also affects GLP1, leading to earlier satiety at mealtimes (think decreased portions/volume) and a longer sense of fullness. There is also new data demonstrating cardiovascular risk reduction of 20% with semaglutide. 
• Zepbound (tizepatide)- Tizepatide is an injection medicine used to treat patients with chronic obesity. In addition to its effectiveness in helping patients lose weight, Tizepatide has shown promise in helping patients reduce blood glucose for patients with Type 2 diabetes and lower cholesterol. Tizepatide, like Semaglutide, affects GLP1 to help reduce both appetite and food intake.

Safety and Effectiveness

The safety and effectiveness of medications used in weight loss can vary depending on the specific medication, individual factors, and adherence to prescribed guidelines. It’s essential to consult with a healthcare provider before starting any weight loss medication to ensure it is a suitable option for your unique circumstances.

Effectiveness

Studies have shown that anti-obesity medications or weight loss medications, when combined with lifestyle changes such as increased physical activity, improved sleep and reduced caloric intake, can lead to more substantial weight loss compared to lifestyle modifications alone.

That being said, every individual has his/her own journey, and the degree of weight loss can vary greatly.

Safety

Weight loss medications are generally considered safe when used as prescribed and under the supervision of an experienced healthcare provider.

The use of compounded versions or “knock-off” medications that are not FDA approved, are not tested for safety and efficacy, is strongly discouraged.

Common side effects vary depending on the particular medication. 

For oral medications such as phentermine, phentermine/topiramate (Qsymia), bupropion/naltrexone (Contrave), these may include decreased appetite, increased anxiety, increased heart rate, elevated blood pressure, headache, nausea, constipation. 

For the GLP and GLP/GIP medications such as Saxenda, Wegovy, Ozempic (off-label) and Mounjaro (off-label) the most common side effects are nausea/vomiting, diarrhea, constipation, indigestion, and decreased appetite. 

It’s crucial to discuss your medical history, current medications-including supplements, and any potential contraindications with your healthcare provider to ensure the safety of weight loss medication use. Women of child-bearing age need to particularly mindful about pregnancy prevention while taking AOMs (Acute otitis media).

The Importance of Lifestyle Changes

Weight loss medications are only recommended as part of an overall, comprehensive weight loss approach and should NOT be used in isolation or without medical supervision. Patients can end up consuming a “semi-starvation” diet which can lead to significant loss of lean muscle tissue which can have detrimental long term side effects. 

Every effort should be made to educate the patient about the risks of losing excess lean mass in the form of muscle tissue. This is accomplished by ensuring adequate protein intake throughout the day and regular physical activity, including strengthening and cardio. 

Here are some important lifestyle factors to consider.

• Healthy Nutrition: We don’t recommend a particular “diet” but rather, we help patients understand what their bodies need versus what we want.  There is a big difference and while we don’t recommend depriving yourself of those “wants” altogether, healthy nutrition focuses on more beneficial foods and less on those that have low to NO nutritional value. 

• Focus on foods that are rich in whole foods, including fruits, vegetables, leafy greens, nuts, seeds, quality proteins, complex, whole grains, and healthy fats. Monitor portion sizes and practice mindful eating.

• Regular Physical Activity: Engage in regular physical activity that includes both aerobic exercises (e.g., walking, swimming, cycling) and strength training. Aim for at least 150 minutes (about 2 and a half hours) of moderate-intensity exercise per week.

• Behavioral Strategies: Learn and apply behavioral strategies to address emotional eating, manage stress, and establish healthier eating habits.

• Support System: Seek support from healthcare professionals, registered dietitians, or support groups (live or internet based) to help you stay on track and make long-lasting changes.

• Monitoring Progress: Track your weight loss progress, physical activity, and dietary choices to stay accountable and make necessary adjustments.

Comprehensive medical weight loss including the appropriate use of medications, can be a valuable tool for individuals struggling with obesity or those who have not achieved their desired results through lifestyle modifications alone. The science behind these medications demonstrates their potential to aid in weight loss by affecting appetite, metabolism, and fat absorption. However, it’s essential to approach the use of medications with caution, under the guidance of an experienced, appropriately trained healthcare provider, and always in conjunction with sustainable lifestyle changes.

Remember that weight management is a journey that goes beyond the number on the scale. Achieving and maintaining a healthy weight is about fostering a balanced and health-conscious lifestyle that supports both physical and mental well-being.