Medical Weight Loss
Are you an adult who has health problems associated with your weight? Have you tried diet and exercise but haven’t been able to lose enough weight? You’re not alone.
Obesity and its Health Risks
An estimated 61.3 million American adults (30.5%) are obese.
Severe obesity is also on the rise. Around 9.6 million adults have a body mass index (BMI) of 35-40, while 6 million American adults are morbidly obese (BMI 40+).
Excessive body fat leads to many health risks, including an increased risk of premature death.
Obese patients (BMI 30+) are estimated to have a 50-100% increased risk of death from all causes when compared with people of normal weight (BMI 20–25). The risk of premature death increases significantly in cases of morbid obesity (BMI 40+) and super-obesity (BMI 50+).
Most of the increased mortality rate from obesity is due to comorbidities like atherosclerosis, heart attack, or stroke.
Other obesity-related health conditions include:
- Diabetes
- Hyperinsulinemia
- Insulin resistance
- Obstructive sleep apnea
- Shortness of breath
- Asthma attacks
- Gastroesophageal reflux disease
- Low back pain
- Arthritis
- Heartburn
- Urinary incontinence
- Venous disorders
(Source: US Census 2000; NHANES III data estimates)
Weight Management Medications
Prescription medications to treat overweight individuals and obesity work in different ways. Some medicines may help you feel less hungry or full sooner. Other medications may make it harder for your body to absorb fat from your food. Weight management medications are meant to help people who have health problems related to overweight or obesity. Healthcare professionals use a patient’s BMI to help decide whether they might benefit from weight management medications. Your healthcare professional may prescribe a medication to treat your overweight or obesity if you are an adult with:
- a BMI of 30 or greater
- a BMI of 27 or greater, and you have weight-related health problems such as high blood pressure or type 2 diabetes
- Weight management medications aren’t for everyone with a high BMI.
If you are overweight or obese, you might be able to lose weight with a lifestyle program that changes your behaviors and improves physical activity and eating habits. A lifestyle program may also address other things that cause you to gain weight, such as eating triggers and not getting enough sleep.
Prescription drugs approved by the FDA for chronic weight management are listed below. The FDA has approved six of these drugs—orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound)—for long-term use. Four of these drugs are approved for adults and children ages 12 and older. Another approved drug, setmelanotide (IMCIVREE), is limited to people who have been diagnosed with one of four specific rare genetic disorders, which must be confirmed by genetic testing. You can keep taking these medications as long as you are benefiting from treatment and not experiencing serious side effects.
Some weight management medications that curb appetite, such as phentermine, are approved by the FDA only for a few weeks. Although some healthcare professionals prescribe them longer, only a few research studies have examined their safety and effectiveness for long-term use.
These medications have side effects, some of which could be severe. Before taking any medication to treat obesity, discuss the possible risks and benefits with your healthcare professional.
- Ask your healthcare professional if you have medical conditions that could increase your risk of developing health problems when taking weight-loss medications.
- Weight-loss medications may have harmful interactions with other medicines you are taking. Discuss any prescribed medications, over-the-counter medications, or herbal products you take. Do not combine weight-loss medications with other products intended for weight loss unless prescribed by a health care professional.
- People taking certain weight-loss medications have reported having suicidal thoughts or actions, and the FDA continues to look into whether the medication causes this.
- People who are pregnant or planning to become pregnant should not take weight-loss medications, as they may harm the fetus. Weight-loss medications are not recommended for people who are breastfeeding.
- Before taking a weight-loss medication, tell your doctor about any allergies or sensitivities.
Semaglutide (Wegovy, Ozempic)
Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It was FDA approved in 2021. It is administered as an injection and approved for use in adults and children aged 12 years or more with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children) or some adults with excess weight (BMI ≥27) (overweight) who also have weight-related medical problems. The dose must be gradually increased over 16 to 20 weeks to reach the 2.4 mg dosage. This progression can help to alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. Ozempic is the same medication but is approved to treat type 2 diabetes.
Tirzepatide (Zepbound, Mounjaro)
Tirzepatide was previously approved to treat type 2 diabetes as Mounjaro. As Zepbound, it is approved to treat obesity in adults with a BMI of 30 or greater. It is both a GLP-1 and a GIP receptor agonist and, like semaglutide, works by reducing appetite and is meant to be combined with diet and exercise to lose weight. It is also administered as an injection.
Liraglutide (Saxenda)
Liraglutide is a daily injectable medication that acts on hormones from the gut that send signals to the brain to make the patient feel full quickly and decrease hunger signals. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5–10% of their body weight, especially with a higher dose of liraglutide. Side effects include nausea, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, fatigue, dizziness, abdominal pain, increased lipase, and renal insufficiency. It is contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.
Phentermine (Adipex, Suprenza)
Phentermine is the oldest and most widely used weight loss medication. It was initially used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy. Some patients may lose about 5% of their body weight by taking phentermine. In the US, phentermine is almost exclusively available in the HCl formulation, with 15 and 30 mg strength. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor. Interactions may occur during or within 14 days following monoamine oxidase (MAO) inhibitors, sympathomimetics, alcohol, adrenergic neuron-blocking drugs, and possibly some anesthetic agents.
Phentermine-topiramate (Qsymia)
Topiramate can be combined with phentermine to decrease appetite and cravings. Having the combination of two drugs increases efficacy. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5–10% of body weight. If more than 5% weight loss is not achieved after 12 weeks of the maximum dose, the weight loss pill should be gradually discontinued. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg. Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth. Contraindications include uncontrolled hypertension and coronary artery disease, hyperthyroidism, glaucoma, and sensitivity to stimulants.
Naltrexone-bupropion (Contrave)
Naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Some patients may lose 5–10% of body weight. Start with a daily dose of one 8/90 mg tablet and gradually increase to four daily tablets. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. This medication should not be prescribed to a patient who has a seizure disorder or who takes opioids for chronic pain.
Setmelanotide (Imcivree)
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years of age and older with obesity due to one of several specific rare genetic disorders. The condition must be confirmed by genetic testing demonstrating variants in POMC, PCSK1, or LEPR genes interpreted as pathogenic, likely pathogenic, or of a variant of uncertain significance (VUS).
Orlistat (Xenical and Alli)
Orlistat is a lipase inhibitor that comes in a capsule and works by blocking the enzyme that breaks down fats consumed through food. In this way, it inhibits the absorption of dietary fats. The undigested fat is then passed through the body. It is intended for use with a reduced-calorie diet and is also indicated to reduce the risk of weight regain. Some patients may lose about 5% of their body weight. The dosage is one 120 mg capsule three times a day, with each main meal containing fat (during or up to 1 hour after the meal). An over-the-counter formulation is available in 60 mg capsules, with each meal that contains fat. The most common adverse reactions to orlistat are oily discharge from the rectum, flatus with discharge, increased defecation, and fecal incontinence.
Side effects and other reactions to weight management medications are possible. For more information, visit the FDA drug database.
What are the benefits of using prescription medications to lose weight?
When combined with lifestyle and behavior changes, including healthy eating and increased physical activity, prescription medications help some people lose weight and maintain weight loss. On average, after one year, adults who take prescription medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program who do not take medication. Less information is available for children ages 12 and over, but ranges appear similar.
Research shows that some people taking prescription weight management medications lose 10% or more of their starting weight. Results vary by medication and by person, with more than half of participants losing 10% or more of their starting weight with some medicines.
Weight loss of 5% to 10% of your starting body weight may help improve your health by lowering blood sugar, blood pressure, and triglyceride levels. Losing weight also can improve some other health problems related to overweight and obesity, such as joint pain and sleep apnea. Most weight loss occurs within the first six months of starting the medication.
Comprehensive, personalized, non-surgical weight loss programs are available. Medical weight loss is not a “one diet fits all” program. It is weight management that targets the root causes of obesity and weight gain and is specialized for the patient. Physicians on our staff use a variety of medical approaches and medication to help you safely lose weight. Many insurances cover non-surgical treatments for obesity.