An introduction into weight loss prescription drugs
Losing weight can be a journey full of twists and turns, and some people turn to weight loss drugs for a boost. However, it’s important to note that taking these drugs come with both benefits and risks. For those considering weight loss drugs, understanding these potential effects is crucial. This guide will provide a comprehensive overview of the risks and benefits of taking weight loss drugs, allowing you to make an informed decision about whether or not they are right for you. Here, you’ll learn about how weight loss drugs work, how much they cost, the top five prescribed by doctors, and any potential health effects associated with them.
Of course, it’s worth noting that weight loss drugs are not the only option for weight loss, methods such as nutrition coaching and/or personal training are effective ways to achieve weight loss or physique goals and tend to be more sustainable and healthier in the long run.
How do I get a prescription for weight loss drugs?
Obtaining a prescription for weight loss drugs can be difficult as they are generally only prescribed to individuals who meet certain criteria, such as having a body mass index (BMI) of 30 or higher (i.e., obese), or a BMI of 27 or higher with weight-related health issues (i.e diabetes). Additionally, these drugs are often only prescribed as a last resort after other weight loss methods, such as diet and exercise, have been attempted and proven ineffective. Your health care provider will also consider your medical history and health challenges before choosing a medicine for you.
How do weight loss drugs work?
There are several different types of weight loss drugs. The medications work differently in each individual, but they all have the same general goal: to reduce your appetite, increase your metabolism, or break down fat. It is important to note that not all of the drugs listed below are FDA-approved for weight loss. Some of them are approved for other conditions, but are used off-label for weight loss as well. Even though these drugs are unregulated, they are still widely prescribed and used.
It’s also important to note that there are many different types of weight loss drugs, such as appetite suppressants, anti-obesity agents, anti-diabetic agents, anti-hypertensive agents, and anti-psychotic agents. Each type of drug works differently and has different potential side effects. It’s crucial to consult with a healthcare professional to determine the best course of treatment for you.
Categories of prescription weight loss drugs:
– Appetite suppressants: These drugs reduce the feeling of hunger and can help you eat less without changing your diet. They are generally used in combination with other types of drugs.
– Anti-obesity agents: These drugs affect hormones and neurotransmitters that control eating and metabolism. They promote a feeling of fullness so that you eat less and can lead to weight loss over time.
– Anti-diabetic agents: These drugs lower blood sugar and insulin levels. This can help reduce cravings and prevent weight gain from insulin resistance.
– Anti-hypertensive agents: These drugs reduce blood pressure, lowering the risk of heart disease, stroke, and diabetes. Lower blood pressure can also help you lose weight.
– Anti-psychotic agents: These drugs alter the way your brain processes dopamine, the chemical that influences your mood and appetite.
The top weight loss drugs
- Phentermine: Phentermine is an appetite suppressant that targets the hypothalamus, a region of the brain that plays a key role in regulating appetite and body weight. It increases the release of norepinephrine and dopamine, which are neurotransmitters that suppress appetite and increase energy expenditure. Phentermine also increases the release of other neurotransmitters such as serotonin, which further suppress appetite and increase satiety.
- Orlistat: Orlistat is a lipase inhibitor that works by blocking the absorption of dietary fats, reducing calorie intake, specifically targeting gastrointestinal lipases which are enzymes that break down dietary fats into smaller molecules that can be absorbed by the body. Orlistat attaches to the active site of the lipase enzyme, preventing the enzyme from breaking down dietary fats. This leads to a decrease in the absorption of dietary fats, which results in decreased calorie intake and weight loss.
- Liraglutide: Liraglutide works by mimicking the action of a naturally occurring hormone called GLP-1 (glucagon-like peptide-1). GLP-1 is a hormone that is secreted by the gut in response to food intake, it plays a role in regulating appetite, glucose metabolism, and insulin secretion. By mimicking the action of GLP-1, liraglutide helps to reduce appetite and increase feelings of fullness, which can lead to weight loss.
- Tirzepatide: Tirzepatide is an injectable dual GLP-1 receptor and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. It has a greater affinity to GIP receptors than to GLP-1 receptors, and this dual agonist behavior has been shown to stimulate insulin secretion and suppress glucagon secretion. This helps to lower blood glucose levels and improve glucose control in people with type 2 diabetes. It also improves beta-cell function, which helps to reduce A1C levels. Much like liraglutide, it helps reduce appetite and increase feeling of fullness.
- Lorcaserin: Lorcaserin targets serotonin 2C receptors, which are found in the hypothalamus, a region of the brain that plays a key role in regulating appetite and body weight. When these receptors are activated, they release a cascade of signals that reduce appetite, increase feelings of fullness and satiety, and decrease food intake. Lorcaserin was withdrawn from the market in 2020 by the FDA.
The newest weight loss drug: Tirzepatide
The hottest drug on the market is tirzepatide, which is currently a diabetes medication being considered for use to treat obesity and help patients lose weight, like the related drug semaglutide. It works by stimulating the release of insulin from the pancreas, which helps with blood sugar control, and as a GLP-1 receptor antagonist, the drug can help people feel more full.
The hormones GLP-1 and GIP are both involved in the regulation of appetite and satiety. GLP-1 is released from the gut in response to food intake and acts as an inhibitor of food intake, while GIP is released from the gut in response to carbohydrates and acts as an appetite stimulant. Both hormones act on the brain to regulate appetite, with GLP-1 acting on the hypothalamus to decrease appetite and GIP acting on the mesolimbic reward system to increase appetite. GLP-1 also inhibits gastric emptying and increases satiety, whereas GIP increases the secretion of insulin to control blood glucose levels.
In a recent phase 3 double-blind, randomized, controlled trial, 2539 adults with a body-mass index (BMI) of 30 or more were assigned to receive once-weekly, subcutaneous doses of tirzepatide (5 mg, 10 mg, or 15 mg) or placebo for 72 weeks. The trial results showed that all doses of tirzepatide led to substantial and sustained reductions in body weight, with the highest dose (15 mg) resulting in a 20.9% decrease in weight compared to a 3.1% decrease in the placebo group. Additionally, the study showed that tirzepatide improved cardiometabolic measures and caused only mild to moderate gastrointestinal adverse events. Based on this (and other) data, the FDA has granted Fast Track designation to Eli Lilly and Company’s investigational drug, tirzepatide, for the treatment of obesity in adults. This designation will expedite the development and review process of the drug. The company plans to submit a new drug application (NDA) for tirzepatide this year, based on the results of two Phase 3 clinical trials, SURMOUNT-1 and SURMOUNT-2. Assuming positive results, the rolling submission process will allow the company to complete the NDA shortly after SURMOUNT-2 data becomes available.
How much do weight loss drugs cost?
The cost of weight loss drugs can also be a barrier for many individuals, as they are sometimes not covered by insurance and can be expensive. For example, the weight loss drug Orlistat (brand name Xenical) can cost over $200 for a one-month supply, while the prescription weight loss drug Phentermine can cost over $150 for a one-month supply. However, some weight loss drugs like Liraglutide (brand name Saxenda) are more expensive and can cost more than $1000 per month. It’s worth noting that these prices may vary depending on the location. The other issue is availability as some weight loss drugs are hard to find if they are new (i.e., tirzepatide).
In comparison, the cost of nutrition coaching or personal training can also vary depending on factors such as the location, the experience and qualifications of the coach or trainer, and the duration and frequency of the sessions. On average, nutrition coaching can cost anywhere from $100 to $500 per month, and personal training can cost anywhere from $50 to $250 or more per session. The main difference being that with a coach you’ll learn how to train and eat effectively for your physique goals in a sustainable manner. Yes, it may be more difficult, but it’s worth the investment to learn how to eat and exercise for a healthy lifestyle, even if your goals change over time.
Potential risks of taking weight loss drugs
Of course there are risks when taking weight loss drugs and it mainly depends on the specific drug you’re taking, the dosage you’re taking, and your individual health. Nothing is 100% safe, but generally speaking, weight loss drugs are safe when you take them as prescribed by a doctor. However, you should know that there are some side effects that can come with the territory, like
- Stomach issues: Some weight loss drugs can give you some stomach problems like nausea, vomiting, abdominal pain, and diarrhea.
- Heart troubles: Certain weight loss drugs can put your heart at risk, including high blood pressure, heart attack, and stroke.
- Headaches: Some weight loss drugs can give you a headache, especially when you first start taking them.
- Sleep issues: Some weight loss drugs can mess with your sleep, especially when you first start taking them. So, always talk to your doctor before taking any weight loss drugs.
Potential benefits of taking weight loss drugs
Weight loss drugs, when taken as prescribed and if you are healthy, can be a powerful tool to help you lose weight quickly. Additionally, these drugs may help to reduce the risk of developing certain diseases such as diabetes and improve certain aspects of mental health such as mood and anxiety.
Are weight loss drugs right for everyone?
There are many myths surrounding weight loss drugs, and many people believe that these drugs are safe for everyone. However, this is not the case. Weight loss drugs are not right for everyone, and should be used as a last resort. Before taking weight loss drugs, consider the following factors:
Your diet: There are many myths surrounding what you should and shouldn’t eat when dieting. While there are certainly healthier options than others, it’s worth talking with a nutrition coach to make sure you are getting everything your body needs to reach your goals.
The amount of exercise you are doing: You don’t need to be working out every single day, but you should be doing at least some exercise each week. Exercising regularly can help you lose some weight and help prevent you from gaining it back again
Your overall health: Before taking weight loss drugs, you should always see your doctor. This way, you can make sure that you are healthy enough to take them and that they are the right choice for you.
Alternatives to taking weight loss drugs
Weight loss drugs are not a one-size-fits-all solution. It’s important to remember that these drugs should be used as a last resort and are not right for everyone. Before considering weight loss drugs, it’s important to take a holistic approach and consider other factors such as your diet, the amount of exercise you are doing, and your overall health.
An alternative to weight loss drugs is personalized coaching. Personalized coaching can include working with a dietician or nutrition coach, personal trainer, and a therapist to help with a holistic approach to weight loss and maintenance. This approach can be more sustainable, healthier, and tailored to individual needs in the long run.
Below are some of the benefits of eating healthy outside of just losing weight:
- Improved digestion: Eating a diet rich in fruits, vegetables, and whole grains can provide your body with the necessary fiber to keep your digestion regular.
- Better nutrient intake: Eating healthy foods ensures that your body is getting all the necessary vitamins, minerals, and other micronutrients it needs to function properly.
- Increased energy: Eating a diet high in nutritious foods can give you more energy throughout the day, as opposed to feeling tired and sluggish.
- Lowered risk of chronic diseases: Eating a healthy diet can lower your risk of developing chronic diseases such as heart disease, diabetes, and certain types of cancer.
- Improved mental health: Eating a diet high in fruits, vegetables, and lean proteins can help improve mood, reduce stress and improve overall mental health.
Additionally, eating a healthy diet is a sustainable approach to weight loss and maintenance, rather than relying on short-term fixes like weight loss drugs, which may not provide long-term health benefits.
When taken as prescribed, weight loss drugs can be an effective way to lose weight. However, they should be used as a last resort, after trying other methods for several months. Before taking weight loss drugs, it is important to always consult your doctor, make sure you are healthy enough to take them, and understand the risks and benefits of each drug.
- “Weight-Loss Drugs: What You Need to Know” (https://www.fda.gov/consumers/consumer-updates/weight-loss-drugs-what-you-need-know)
- “Weight Loss Drugs” (https://www.niddk.nih.gov/health-information/weight-management/weight-loss-drugs)
- “Weight Loss Medications” (https://www.obesityaction.org/obesity-treatments/weight-loss-medications/)
- “Weight-Loss Drugs” (https://www.aafp.org/afp/2013/0501/p719.html)
- Gadde, KM, Allison, DB, Ryan, DH, et al. (2016). Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial. The Lancet, 377(9774), 1341-1352.
- Smith, SR, Weissman, NJ, Anderson, CM, et al. (2014). Multicenter, placebo-controlled trial of lorcaserin for weight management. The New England Journal of Medicine, 370(2), 139-148.
- Apovian, CM, Aronne, LJ, Rubino, D, et al. (2015). A randomized, controlled trial of 3.0 mg of liraglutide in weight management. New England Journal of Medicine, 373(1), 11-22.
- Padwal, RS, Majumdar, SR, McAlister, FA, et al. (2011). Long-term drug treatment for obesity: a systematic and clinical review. Lancet, 378(9793), 941-947.
- Wadden, TA, Foreyt, JP, Foster, GD, et al. (2002). A randomized trial of lifestyle modification and pharmacotherapy for obesity. Obesity Research, 10(5), 432-439.