February 20, 2023
Whether you’re in the market or not, chances are you’ve heard there have been major developments in weight loss medication over the past couple of years. New injectable drugs are providing significant results — we’re talking on average 5% to 15% of body weight lost. That’s a big deal.
“Losing just 5% of your body weight can result in significant benefits to your health,” says Victoria Newcom, a family nurse practitioner at MU Health Care’s Weight Management and Metabolic Institute. Even if your weight loss still lands you in the “overweight” or “obese” range, you’ll likely see improvements in your blood pressure, cholesterol and blood sugar levels. And you’ll decrease your risk for obesity-related chronic diseases.
With results like that, the new weight loss medications sound like a perfect solution for more than 40% of adults in the United States who are obese. But, like most things that sounds too good to be true, they’re not for everyone. If you are considering medication for weight loss, here's what you need to know:
1. Obesity Medication Should Be Part of a Bigger Treatment Plan
You should approach obesity treatment from many angles, says Newcom. Weight loss medication isn’t the only answer, and it’s not always effective.
For every type of obesity medication available, there are high responders (those who see maximum, or above average results) and non-responders (minimum, or below average to no results). In clinical trials for semaglutide — one of the most successful injectable anti-obesity drugs — 13% of the participants didn’t lose any weight.
“Medication may help treat the disease,” Newcom says. “But it’s not a standalone solution. It is just one aspect of medically supervised weight loss.”
In addition to any medications or other weight loss measures, a well-rounded approach to weight loss should include:
- Behavioral health provided by a social worker or licensed therapist to address eating habits and emotions tied to food and weight
- Dietary guidance provided by a registered dietitian to ensure you are meeting nutritional requirements
- Lifestyle changes, which may involve improving your sleep and exercise habits
2. Weight Loss Medication Is Not a Quick Fix
Although both medications and weight loss surgery can work to reduce hunger hormones and make you feel fuller longer, anti-obesity drugs work differently than bariatric surgery, which decreases the size of your stomach. Losing weight quickly is common with bariatric surgery, but isn’t always the case for medications. Many experts believe a 5% loss in total body weight within the first three months of drug use is a good predictor of success of the medication. But even when you succeed in losing excess weight, obesity is still a chronic disease requiring ongoing and lifelong treatment.
“People often want to take a medication to lose weight and then stop,” Newcom says. “But we know that when patients discontinue use of weight loss medications, it's very difficult to maintain that weight loss long-term.”
3. Not All Weight Loss Drugs Work the Same Way
Anti-obesity medications take different approaches to weight loss. They can work by:
- Affecting your hunger hormones
- Helping you feel full on less food
- Suppressing appetite and cravings
Weight loss medications can be oral or self-injected:
Oral weight loss medications
Anti-obesity drugs taken by mouth tend to suppress your appetite and/or control food cravings. While there are several oral weight loss drugs available, Newcom says the most commonly prescribed FDA-approved medications include:
- Adipex, Lomaira (phentermine): This stimulant has been available since the 1970s and works to suppress your appetite.
- Qsymia (phentermine-topiramate): This combination of stimulant and anticonvulsant (used to treat seizures and headaches) suppresses appetite. According to Newcom, experts and patients agree it’s “the most potent and effective oral medication for most patients.”
- Contrave (bupropion-naltrexone): Used separately, these drugs treat depression and opiate addiction. In combination, they work to lower your appetite and suppress cravings.
Injectable drugs
Injectable drugs, initially approved to treat Type 2 diabetes, imitate the GLP-1 hunger hormone that helps reduce your appetite and how much food you eat. “People don’t feel as hungry or have as many cravings,” Newcom says. “These drugs also help slow gastric motility (how quickly your stomach empties). It keeps food in your stomach to help you feel fuller longer.”
While there are many drugs in the GLP-1 class approved to treat diabetes, only two brands are FDA-approved for weight loss:
- Wegovy (semaglutide) may reduce body weight by approximately 15% on average.
- Saxenda (liraglutide), an older GLP-1 drug, helps people lose around 5% of their body weight on average.
A new injectable medication called tirzepatide, currently only FDA approved for Type 2 diabetes, is expected to be approved by the FDA for weight management sometime in 2023. In addition to GLP-1, tirzepatide works on another hormone receptor, GIP. That hormone helps your body break down sugar and fat more efficiently. In a clinical trial, some participants taking tirzepatide lost as much as 25% of their body weight.
4. Several Factors Can Determine Which Weight Loss Medication to Take
Deciding which weight loss drug to try isn’t as easy as choosing which shoes to wear with your outfit. Your health care team will consider several factors before recommending an anti-obesity drug:
- Insurance coverage: Your insurance may only pay for specific medications, or none at all.
- Personal goal: Different drugs yield different results. If you need or want to lose more than 100 pounds, surgery might be a better option.
- Cost: Anti-obesity drugs can cost as much as $1,500 or more per month if not approved by insurance. Remember, these are medications you’ll likely need to take for the rest of your life.
- Current medications: Your health care team will look closely at your current medication list to uncover possible drug interactions.
- Past and current medical history: Injectables are safer for patients with heart conditions. But some health conditions may limit your options for oral weight loss drugs, including:
- Glaucoma
- Heart attack
- Hyperthyroidism
- Kidney stones
- Seizures
- Suicidal or homicidal ideations
- Uncontrolled high blood pressure
5. Not Everyone Can or Should Take Weight Loss Medication
Most people might say they’d like to lose some excess weight. But anti-obesity medications are not appropriate for everyone. FDA-approved weight loss medications require patients to meet one of two criteria:
- BMI (body mass index) greater than 30, or
- BMI greater than 27, plus a severe obesity-related health condition (such as diabetes or high blood pressure)
“You should also avoid taking weight loss medication if you are actively trying to become pregnant,” Newcom says. “Most of these medications aren’t studied on pregnant women.”
Next Steps and Useful Resources
- Want to learn more about medical weight loss? Read more.
- Considering weight loss surgery? See if you’re a candidate.
