In the quest for a healthier lifestyle, many individuals turn to weight loss medications and supplements. These options range from prescription drugs to over-the-counter herbal remedies. Medications that help to lower blood sugar levels and promote weight loss have emerged as a promising new option for people who struggle with their weight. These drugs, known as GLP-1 agonists, have proven to be very effective. However, it's crucial to approach these aids with caution, understanding their ingredients, potential side effects, and how to use them safely. This article provides a detailed overview of various weight loss medications, their mechanisms, and essential considerations for anyone contemplating their use.
The Rise of Weight Loss Medications
With over two-thirds of Americans classified as overweight or obese, the demand for effective weight loss solutions is significant. Supplement companies are cashing in. The obesity epidemic is not going away, and it’s easy for companies to see how a pill for this will maximize profits. Anti-obesity medications help many patients lose weight and keep it off. Medication can be part of a comprehensive obesity treatment plan. This has led to a surge in both prescription and over-the-counter (OTC) weight loss products, each promising rapid and significant results. However, the supplement market is very lightly regulated, and the weight-loss products you can buy online, via infomercial, or in nutrition stores could contain any number of hazardous substances, he explains. Even if the ingredients are approved for consumer use, they may contain chemical variations of banned or dangerous substances and dosages that are well above what has been deemed safe.
Prescription Weight Loss Medications: A Closer Look
Several prescription medications are available to aid weight loss, each working through different mechanisms in the body.
GLP-1 Agonists: Semaglutide and Liraglutide
These medications, including semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda), are GLP-1 agonists. They mimic a natural hormone in the body that regulates appetite and blood sugar levels. These drugs have proven to be very effective. However, like many medications, they may come with gastrointestinal (GI) side effects that can impact a patient’s comfort and adherence.
Common Side Effects and Management:
- Nausea and vomiting
- Acid reflux
- Bloating
- Stomach cramps
- Diarrhea and/or constipation
To minimize these side effects, it's essential to:
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- Think about your food choices: Limiting high-fat and greasy foods that take longer to digest can minimize nausea and cramping. Limiting concentrated sweet foods and sugary beverages will also help reduce side effects. To help reduce acid reflux, limit spicy foods and choose bland foods that are easily tolerated, especially if you have been having more episodes of reflux. If you have constipation, don’t forget to include high fiber foods like fruits, vegetables, legumes and whole grains. Finally, remember to stay hydrated by drinking plenty of water!
- Re-think portion sizes: When you start taking GLP-1 medications, you will likely begin to feel full much sooner than usual when eating a meal. This is the intended effect of the medication, but it can take time to get used to. Start out by serving yourself and eating smaller portions. Listen to your body when it starts to feel full so that you don’t feel nauseated after eating.
- Listen to your body: Get in touch with your body’s signs of fullness and stop eating at the first sign of fullness. You may find that eating small, frequent meals will help you get enough protein and calories. While reduced appetite is often a desired effect, it’s crucial to still meet your daily nutritional needs. Pay attention to the number of hours between meals since your body may not give you hunger cues to eat. If you are feeling nauseated, drinking unsweetened ginger or peppermint tea may help.
- Prioritize adequate nutrition: Even if you aren’t feeling hungry, it’s important to still consume healthy nutrients to preserve muscle mass and lean body mass. While it is best to get nutrition through whole foods, a protein drink can help provide your body with nutrients without making you feel nauseous.
It is also important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects. Communicate regularly to ensure they can make adjustments to your dosage.
Important Considerations:
- Eligibility for semaglutide or liraglutide typically requires a BMI of 30 or greater, or a BMI of 27 or greater with comorbidities such as high blood pressure, diabetes, or high cholesterol.
- A 2023 analysis found that 68% of people taking semaglutide or liraglutide for weight loss stopped within a year, with 4.5% citing digestive side effects as the reason. Because stopping one of these medications comes with a high risk of weight regain, a person taking them should understand the risks.
- A paper published in late 2023 in JAMA quantified gastrointestinal adverse events ranging from nausea to pancreatitis.
- Headlines have warned of increased suicidal ideation associated with semaglutide.
Phentermine and Phentermine-Topiramate
Phentermine, available since 1959, decreases hunger by working at the brain level. It is also used in combination with topiramate. Phentermine combined with topiramate cannot be taken during pregnancy. The benefit of this combination is that two medications are working together to decrease hunger and increase fullness.
Side Effects:
- Headache
- Overstimulation
- High blood pressure
- Insomnia
- Rapid or irregular heart rate
- Tremor
- Abnormal sensations
- Dizziness
- Altered taste
- Constipation
- Dry mouth
Contraindications:
- Uncontrolled hypertension and coronary artery disease
- Hyperthyroidism
- Glaucoma
- Sensitivity to stimulants
Important Considerations:
- Interactions may occur during or within 14 days following the use of monoamine oxidase (MAO) inhibitors, sympathomimetics, alcohol, adrenergic neuron-blocking drugs, and possibly some anesthetic agents.
- This medicine may be habit-forming. If you think this medicine is not working properly after you have taken it for a few weeks, do not increase the dose. Instead, check with your doctor.
- This medicine may cause pulmonary hypertension (increased blood pressure in the lungs).
- Serious heart or blood vessel problems (eg, valvular heart disease) may also occur if you take more of it, if you take it for a longer time, or if you are taking other medicine that reduces appetite (eg, dexfenfluramine (Redux®), fenfluramine (Fintepla®)). Check with your doctor right away if you have chest pain, decreased ability to exercise, fainting, swelling of the feet or lower legs, or trouble breathing.
- If you will be taking this medicine for a long time, do not stop taking it without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely.
- This medicine may cause some people to become dizzy, lightheaded, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
- This medicine may increase the risk of seizures. Check with your doctor right away if you have loss of bladder control, muscle spasm or jerking of extremities, or sudden loss of consciousness.
- This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures (including barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you are taking this medicine.
- Symptoms of an overdose include: dilated or enlarged pupils, confusion, panic, restlessness, seeing, hearing, or feeling things that are not there, trembling or shaking in the legs, arms, hands, or feet.
- Do not take other medicines unless they have been discussed with your doctor. This includes prescription and nonprescription (over-the-counter) medicines, dietary supplements, herbal remedies, or medicines for appetite control, asthma, colds, cough, hay fever, and sinus problems.
Naltrexone-Bupropion
This combination medication can help with fullness and cravings.
Side Effects:
- Nausea
- Constipation
- Headache
- Vomiting
- Dizziness
- Insomnia
- Dry mouth
- Diarrhea
Contraindications:
- Seizure disorder
- Use of opioids for chronic pain
Orlistat
Orlistat is a lipase inhibitor that works by blocking the enzyme that breaks down fats consumed through food, thereby inhibiting the absorption of dietary fats. The undigested fat is then passed through the body.
Side Effects:
- Changes in bowel habits
Tirzepatide
Tirzepatide was initially approved to treat type 2 diabetes. In 2023, it was approved for weight loss. As a GLP-1 and GIP receptor agonist, it increases feelings of fullness and helps people maintain a more restrictive diet.
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Side Effects:
- Constipation
- Upset stomach
- Bloating
- Diarrhea
Potential Serious Side Effects:
- Stomach problems
- Kidney problems or failure
- Gallbladder problems
- Pancreatitis
- Hypoglycemia
Phendimetrazine
Phendimetrazine is commonly used to help people with obesity or people who are overweight lose weight. Phendimetrazine may also be used for other conditions as determined by your health care provider.
Common Side Effects:
- Feeling of skipped heartbeats
- Fast heartbeat
- High blood pressure
- Feeling restless
- Dizziness
- Trouble sleeping
- Tremors
- Sweating more than usual
- Headache
- Dry mouth
- Nausea
- Diarrhea
- Increased urination
Serious Side Effects:
- Pulmonary Hypertension
- Heart Valve Problems
- Severe Allergic Reactions
Contraindications:
- Allergies to Ingredients
- Heart Disease
- High Blood Pressure
- Pulmonary Hypertension
- Thyroid Problems
- Agitation
- Substance Use Disorder
- Eye Problems
- Pregnancy
- Breastfeeding
- Drug Interactions
Over-the-Counter (OTC) Weight Loss Supplements: A Risky Business
The OTC weight loss supplement market is vast and largely unregulated. These products often promise quick results through "natural" ingredients, but their efficacy and safety are frequently questionable.
The Dangers of Hidden Ingredients
Many OTC weight loss supplements contain hidden drug ingredients that can be harmful. Numerous public notifications from regulatory agencies highlight products found to contain undeclared and potentially dangerous substances. Some examples include:
- FATZorb
- Toki Slimming Candy
- LipoFit Turbo
- THERMO SHOCK
- ITCHA XS
- Body Shape Weight Loss System
- Govvi WOW!
- Phentamene XT
- NORF 20
- Alfia Weight Loss Capsules
- Lipopastilla + Gold Max
- Dr. Reade Slim Sense
- Hydro Pinapple [sic] Burn
This is just a small sample of a much larger list of products found to contain hidden drug ingredients, underscoring the risk associated with unregulated supplements.
Potential Health Risks
OTC weight loss supplements can pose significant health risks, including:
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- Heart Damage: Many supplements work by speeding up metabolism and heart rate, which can damage the heart muscle.
- Increased Stroke Risk: Stimulants found in these supplements can overstimulate the heart, increasing the risk of stroke.
- Liver Damage: The liver must process the ingredients and chemical byproducts of these supplements, which can lead to a build-up of toxic enzymes.
- Other Side Effects: DNP overdose can cause itchy, inflamed skin and cataracts.
Atrafen Elite: An Example of a Controversial Supplement
Atrafen Elite is a natural supplement that claims to help reduce appetite and promote thermogenesis for higher fat burn. While marketed as a natural supplement, its ingredients and claims warrant a closer look.
Key Ingredients:
- Caffeine: A stimulant that may help mobilize fat and boost metabolism.
- Phenethylamine: Claimed to improve athletic performance, depression, and weight loss, but lacking scientific evidence.
- Nettle Leaf Extract: Marketed for weight loss, but without supporting studies; may act as a diuretic.
- Calcium Carbonate: May slightly increase thermogenesis.
- Yohimbe extract
- Inositol Niacinate
- Caffeine glucuronolactone
Concerns:
- Some ingredients lack scientific data to support their use in weight loss.
- The supplement contains stimulants, which can pose risks for some individuals.
- The manufacturer's claims may not be fully substantiated.
Nutratech Atrafen: Another Example of a Controversial Supplement
Nutratech Atrafen is a fat burning diet pill sold through Amazon.
Key Ingredients:
- Raspberry Ketones: Scientifically it has been proven to aid in weight loss by weakening the fat cells in the body and making them much more likely to be broken down during exercise.
- Kelp: Kelp contains a good level of Iodine which does help in keeping the metabolism healthy but in a regular diet iodine deficiency is incredibly rare.
- Acai: Acai does have some wonderful anti-oxidant qualities that offer multiple benefits to the user.
- Resveratrol: Research is still quite minimal on this compound but so far very little evidence has been found to support its fat-fighting capabilities.
- Green Tea: Along with a healthy diet, the energy you are being given by this caffeine-rich ingredient will help you burn away excess fat.
- Glucomannan: Inside the stomach, it expands to help you feel fuller for longer. It has a very low-calorie content and reduces the absorption of fats.
- Garcinia Cambogia: This fruit extract shot to fame recently for its role in reducing hunger cravings.
Concerns:
- Due to the high levels of caffeine in these diet pills, there is always a small risk of dizziness, cramps, tremors or sickness.
- The reviews on Amazon are positive with an average rating of over 4 stars out of 5. This may be explained by the deal the company offers. A lot of the higher reviews remark that the energy boost is better with a glass of water and on an empty stomach. The lower reviews comment on the fact that there is a much higher need to go to the bathroom, presumably because of the extra diuretic intake.
- This diet pill is certainly not the cheapest on the market, and although it does have some good reviews this is clouded by the fact the makers give people a free bottle if they leave a five-star review.
Diet Pills and Eating Disorders: A Dangerous Connection
The misuse of diet pills and weight loss supplements can be a gateway to eating disorders. The promotion of weight loss supplements or diet pills as a way to lose weight can be directly connected to disordered eating. Given the pressure to lose weight within diet culture, these pills and supplements are sometimes advertised to capitalize on individuals’ desperation or insecurity. A study in the American Journal of Public Health found that those who used diet pills or laxatives for attempted weight manipulation had a higher risk of being diagnosed with an eating disorder for the first time within three years.
How Diet Pills are Misused
- Combining multiple diet pills at once
- Taking prescription weight loss drugs without a doctor’s supervision
- Taking more than the recommended daily dose of a dietary supplement
- Combining diet pills with diuretics and/or laxatives
- Combining diet supplements with illegal stimulants, such as amphetamines or cocaine
Consequences of Abuse
The health consequences of diet pill and supplement abuse include:
- Insomnia
- Anxiety and nervousness
- Diarrhea
- Rectal bleeding
- Dehydration
- Electrolyte and mineral imbalance
- High blood pressure
- Heart palpitations and irregular heartbeat
- Restlessness and agitation
- Fatigue
- Hepatitis and liver damage
- Kidney problems
Safe and Responsible Use of Weight Loss Aids
If you are considering weight loss medications or supplements, it is crucial to proceed with caution and prioritize your health and well-being.
Consult a Healthcare Professional
Only having a conversation with your doctor could help you determine whether or not the side effects of prescription-grade weight loss pills would be worse than the side effects of living with obesity. Discuss your weight loss goals and medical history with a healthcare provider. They can help you determine if medication is appropriate for you and recommend the safest and most effective options.
Understand the Risks and Benefits
Familiarize yourself with the potential side effects and contraindications of any medication or supplement you are considering. The risks often outweigh the rewards. Be wary of products that promise rapid or dramatic results, as these are often associated with greater risks.
Prioritize Lifestyle Changes
Weight loss medications are most effective when combined with healthy lifestyle changes, including a balanced diet and regular exercise. For most people, the treatment for obesity is not as simple as going on a diet or increasing exercise. Focus on sustainable habits that support long-term weight management.
Be Skeptical of "Miracle" Products
There is no magic bullet for weight loss. Be wary of products marketed with unsubstantiated claims and celebrity endorsements. These are all part of the toxic diet culture.
Monitor Your Health
Regularly monitor your health and report any side effects or concerns to your healthcare provider. It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly.