Our Commitment : Providing Weight Loss Guidance For Your Health and Wellness

Determining whether someone is a candidate for weight loss medications begins with BMI. Typically, medications are prescribed for someone with a BMI of 30 or greater or a BMI of 27 or greater if the person has weight-related health conditions. For each individual case, the clinician and patient should discuss the patient’s current health issues, other medications, and family medical history. The medication’s cost and side effects will also affect the decision.

Traditionally, most anti-obesity medications have been approved by the FDA only for adults. Except for liraglutide and orlistat, which have been approved for quite some time for children more than 12 years of age. But recently FDA has approved 2 more medications for chronic weight management in pediatric patients aged 12 and older with obesity with a BMI of 95th percentile or greater when standardized for age and sex. These medications are Qsymia (a combination of phentermine and topiramate) and Wegovy (Semaglutide).

FDA-approved anti-obesity medications (AOMs) are safe, evidence-based therapies that target specific physiology to improve the disease and are most effective when they are used as part of a comprehensive treatment plan. The amount of weight a person loses depends on the medication they take, their overall health, and other individual factors.

Even as the range of weight loss medications has expanded, some drugs have been withdrawn based on their lack of efficacy as well as safety concerns.

The amount of weight loss possible with semaglutide, according to clinical studies, is significant. A 2022 study of 175 individuals showed 5.9% weight loss at three months and 10.9% at six months. A larger study published in the New England Journal of Medicine showed even greater average loss—14.9%. However, drawbacks of semaglutide include high cost, side effects, and the long-term to indefinite length of treatment. Tirepatide, which has so far only been approved for Type-2 diabetes, has shown approximately 20.9% weight loss with maximum dose in SURMOUNT trial in patients with obesity, without diabetes.

As with all obesity treatment, a person might experience better results with one medication over another. Each person, in partnership with their doctor, should try to find the right combination of treatments that work best for them.

In 2022, The American Gastroenterological Association released recommendations for weight loss medications among patients with obesity who do not respond adequately to lifestyle interventions alone. They listed four first-line options:

• Semaglutide
• Liraglutide
• Phentermine-topiramate extended-release (ER)
• Naltrexone-bupropion extended-release (ER)

They also recommended phentermine and diethylpropion.

They work primarily by regulating hormones in the brain, digestive system, and adipose tissue to suppress appetite and cravings and promote satiety.

Some medications are administered orally and others as subcutaneous injections. When patients ask about weight-loss pills vs. injections, they tend to refer to the two options for GLP-1 RAs.

There are many medications that can be obesogenic or can cause weight gain. Following medications can potentially cause variable weight gain in some individuals.

• Some beta-blockers and calcium channel blockers
• Anti-diabetes medications such as insulins, sulfonylureas, thiazolidinediones, and meglitinides
• Hormone therapies such as glucocorticoids and injectable progestins
• Anti-seizure medications, including carbamazepine, gabapentin, valproate, and pregabalin
• A wide variety of different antidepressants
• Some mood stabilizers
• Migraine medications such as amitriptyline and paroxetine
• Some antipsychotics
• Chemotherapeutic and anti-inflammatory agents

A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery. All weight loss medications work best in the context of a healthy eating plan and exercise. Even when a patient is engaging in exercise and other lifestyle adjustments, medications can help with hunger, cravings, and metabolic preservation.

Some weight management medications are FDA-approved for short-term use and others for long-term use. For example, some are approved by the FDA for up to 12 weeks. Those approved by the FDA for long-term use include orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), and semaglutide (Wegovy, Ozempic). The dosing for some of these includes a long ramp-up period—up to five months—to reach full dosage. Keep in mind that obesity is a disease, and no drug can permanently “cure” it. Just like any other chronic medical disease, the treatment of obesity requires long-term chronic weight management.