Lose Weight Using Drugs

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Obesity is now considered more than a risk factor for other conditions; it's a disease itself. It has been the subject of intense scientific and medical research to develop effective treatments. But the quest has been elusive.

Four medications approved by the FDA since 2012—Qsymia (phentermine and topiramate), Belviq (lorcaserin), Contrave (naltrexone and bupropion ) and Saxenda (liraglutide)—have added to the options for treating obesity, says Dr. Lee Kaplan, who directs the Obesity, Metabolism, and Nutrition Institute at Harvard-affiliated Massachusetts General Hospital. We now have six FDA-approved drugs, but that is a tiny percentage of the number available to treat hypertension and other chronic diseases, so we need even more options to treat obesity most effectively.

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Like older medications, the new drugs are best used as part of a comprehensive weight-loss program that includes close monitoring by an experienced physician. The approved drugs are usually prescribed for people with a BMI higher than 30, especially if they have other conditions such as type 2 diabetes, high blood pressure, joint problems, or sleep apnea, which can often be alleviated by losing weight.

Not everyone responds the same way to any given drug. A few people may lose a great deal of weight on a particular drug, while others may lose little or none. At present we have no way to predict this response in advance, Dr. Kaplan says. Fortunately, however, if you don't respond to one drug, you may do well with another. It often requires trying multiple medications to find the right one for each person.

The weight-loss drugs won't melt off the pounds overnight. When they are successful, they result in an average weight loss of about 5% over a period of six to 12 months. However, even that modest weight loss can improve your and reduce your risk of heart disease, stroke, and diabetes.

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You may remember some disturbing reports about previous weight-loss medications. Dexfenfluramine and fenfluramine were taken off the market after they were linked to heart valve damage. Sibutramine (Meridia) was removed after it was linked to heart attack and stroke in people at highest risk for them.

The options on the market today come with their own cautions. The ingredient phentermine—a component of Adipex-P, Ionamin, and Qsymia—isn't usually recommended for people who have high blood pressure or other heart conditions. Topiramate, another component of Qsymia, has been linked to an increased risk of birth defects, so women who take it should take special precautions not to get pregnant.

If a drug helps you lose 5% of your weight within a few months without side effects, you will likely want to continue it. But medications are not a substitute for lifestyle changes. They work best when used as part of a broader medical weight-loss program. They should be just one part of a lifelong plan that includes a y diet, regular exercise, adequate sleep, and stress reduction.

Prescription Medications & Weight Gain

Some weight-loss medications contain drugs used to treat other conditions. You may want to consider a dual-purpose medication if you have the following:

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No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.With three-quarters of Americans obese or overweight, interest in weight-loss treatments is at an all-time high. Three injectable medications have dominated the spotlight of late: Wegovy, Ozempic and Mounjaro. These once-a-week, injectable drugs are so popular, in fact, that pharmacies routinely run out of stock.

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Many health experts are conflicted about the success of these drugs, however. While life-changing for patients who have long struggled with diabetes, obesity and associated conditions, the medications should not be taken lightly, saidDiana Thiara, M.D., the medical director of UCSF’s Weight Management program.

A: Wegovy is FDA-approved for obesity. Ozempic and Mounjaro are FDA-approved for diabetes. However, the manufacturer of Mounjaro is now seeking FDA approval for the drug to be covered for weight management. We hope to hear more about this by the end of the year.

A: People do lose weight on all three of them, and a lot of physicians are prescribing the diabetes drugs as weight-loss drugs, though that’s not what they are currently approved for.

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A: People on the highest dose of Mounjaro have lost up to 21 percent of their body weight. For the other two, people lose about 12-15 percent of body weight.

A: Past drugs worked mostly in the brain to suppress appetite and help people feel more satisfied with smaller quantities of food. These newer medications work on your brain to make you feel full and also on your body to help keep food in your stomach longer. In addition, they improve your body’s ability to secrete insulin, which controls blood sugar and can help with metabolism.

A: It’s not dangerous to the individual. These medications have been studied and are safe. But it can be problematic in the sense that prescribing diabetes medications for weight loss contributes to medication supply shortages, so people who need the medications for diabetes can’t always get them. Lower socioeconomic status patients seem to be most affected and already experience more health disparities.

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A: Insurance covers them for their intended use, not for the off-label use. If someone is using Ozempic for weight loss and not diabetes, they are either paying out of pocket or their prescriber wrote “diabetes” as the diagnosis so it could be covered.

A: No, these medications for weight loss don’t work that way. There was one study done with Wegovy, called the STEP 4 Trial, that looked at short-term use. Study participants started on the medication for 20 weeks, then, after 20 weeks, half stayed on the medication and half went off. The half who stopped the medication regained almost all of their weight, about 70 percent, after 48 weeks.

A: Yes, it seems so. Obesity is a metabolic disease, just like diabetes or hypertension, and it requires long-term attention. In another study of Wegovy, called the STEP 1 extension study, people were given Wegovy for one year. Half the group stopped the medication, and they regained two-thirds of the weight they had initially lost. In the group that stayed on the medication, they kept off all the weight they lost.

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A: First, you need to get prior authorization through insurance — i.e., approval for it to be covered. It’s challenging because insurance companies change what they cover without telling providers or patients when or why or how. Another issue is, if a patient does get Wegovy covered, they must lose 5 percent of their body weight after five to six months of taking it or else insurance will stop paying for it.

A: Yes, in California, Medi-Cal covers it. The San Francisco Health Plan covers it. Medicare does not; it is a blanket policy that they don’t cover medications for weight loss. They will cover Ozempic and Mounjaro for diabetes, though.

A: Supply chain issues have been a consistent problem ever since this drug came to market. We are experiencing supply chain issues right now, again. I tell patients that the first three doses of Wegovy, where you are gradually increasing the amount, are often on backorder. Patients often have to call around to different pharmacies to see what is in stock at that moment, and sometimes the dose is gone by the time the provider fills the order. Sometimes patients can find one or two doses but not the third. I have patients who drive hours from home to get their doses.

Anti Obesity Medication

A: Sometimes there is a mild allergic skin reaction at the injection site that can be addressed by a cream or an oral allergy medication. There are also common but not serious side effects, such as nausea, diarrhea, fatigue, constipation and upset stomach. Then there are the rare but serious side effects that affect less than 1 percent of people. These are things like pancreatitis, cholecystitis, kidney injury and suicidal ideation. It’s because of these that a provider needs to monitor a patient's symptoms and bloodwork while they are on the medication.

A: Neither the FDA or pharmaceutical companies have advised on this, but in our weight management clinic we are conservative. We get baseline kidney, liver and lipase function lab tests before starting the medications. We meet with patients every four to six weeks during the first five months when they are increasing their dose to make sure they are not having side effects. Around the second dose, we repeat