Are you an adult grappling with serious health issues due to your weight? Have you struggled to lose weight through diet and exercise alone? In certain instances, your health care provider may suggest a weight-loss drug as part of your treatment plan. This article delves into the realm of prescription weight-loss medications, offering a structured overview of their use, benefits, risks, and considerations.
Determining the Need for Prescription Weight-Loss Drugs
Prescription weight-loss drugs aren't for everyone. Your health care provider will consider your medical history and specific health challenges before recommending any medication. Generally, these drugs are considered for individuals who meet specific criteria, such as:
- A body mass index (BMI) greater than 30, indicating obesity.
- A BMI greater than 27, coupled with weight-related health problems like high blood pressure, type 2 diabetes, or high cholesterol.
It's important to remember that these medications are most effective when combined with a comprehensive lifestyle program that includes changes to your behaviors and improves your eating and physical activity habits. Medications don’t replace physical activity or healthy eating habits as a way to lose weight.
How Weight-Loss Medications Work
Most prescription weight-loss drugs work by making you feel less hungry or fuller, or sometimes both. By curbing appetite and increasing satiety, these medications can aid in reducing overall calorie intake. The exception is orlistat, which works differently.
Types of Prescription Weight-Loss Drugs
The FDA has approved several prescription drugs for chronic weight management. Here's a closer look at some of the commonly prescribed options:
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Orlistat (Xenical, Alli): This lipase inhibitor prevents the body from absorbing some of the fat from the food you eat. It is available in both prescription (Xenical) and over-the-counter (Alli) forms. When taking orlistat, it's crucial to follow a low-fat diet to minimize side effects such as passing gas and having loose stools. In rare cases, people have had serious liver injury with orlistat.
Phentermine-Topiramate (Qsymia): This combination drug combines phentermine, a stimulant that suppresses appetite, with topiramate, an anticonvulsant. Phentermine has the potential to be misused because it acts like a stimulant drug called an amphetamine. Other possible side effects include an increase in heart rate and blood pressure, insomnia, constipation, and nervousness.
Naltrexone-Bupropion (Contrave): This medication combines naltrexone, used to treat alcohol and opioid addiction, with bupropion, an antidepressant and quit-smoking aid. Naltrexone-bupropion affects the pleasure-reward areas of the brain, thereby decreasing cravings and appetite. Like all antidepressants, bupropion carries a warning about suicide risk. Bupropion-naltrexone can raise blood pressure. So your provider will need to check your blood pressure regularly at the start of treatment.
Liraglutide (Saxenda, Victoza): Given as a daily shot, liraglutide also is used to manage diabetes. It mimics a naturally occurring hormone in the body that helps control blood sugar, slows down how quickly food leaves the stomach, and may decrease appetite. Nausea is a common complaint.
Semaglutide (Wegovy, Ozempic): Semaglutide is also used to help control type 2 diabetes. 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) who also have weight-related medical problems. The dose must be increased gradually over 16 to 20 weeks to arrive at the 2.4 mg dosage. This progression can help to alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. It is intended to be used indefinitely, in combination with a healthy diet and exercise. Ozempic may be a more familiar name to some patients.
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Tirzepatide (Zepbound, Mounjaro): Zepbound 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. Like semaglutide, it works by reducing appetite and is meant to be used in combination with diet and exercise to lose weight. Tirzepatide is a dual GIP and GLP-1 receptor agonist that suppresses appetite, improves satiety, and supports metabolic health. In the SURMOUNT-1 trial, adults with obesity or overweight (without diabetes) taking tirzepatide achieved up to 22.5% average body weight reduction at 72 weeks. In addition to impressive weight loss, studies show improvements in cardiovascular risk factors and metabolic markers.
Setmelanotide (IMCIVREE): This medication is limited to people who have been diagnosed with one of four specific rare genetic disorders, which must be confirmed by genetic testing. It can lessen your appetite and make you feel fuller. You take setmelanotide as a daily shot. Never give setmelanotide to a child under 6 years old. Setmelanotide doesn't treat any of the gene problems that cause these conditions. But it can help you lose weight.
Phentermine (Adipex-P, Lomaira): Phentermine by itself (Adipex-P, Lomaira) also is used for weight loss. It's one of four similar weight-loss drugs approved for use for less than 12 weeks, called short-term use.
Benefits of Weight Loss with Medication
Prescription weight-loss drugs, when used as part of a comprehensive treatment plan, can offer significant benefits:
Significant Weight Loss: Prescription weight-loss drugs that you can use for more than 12 weeks, called long-term use, lead to major weight loss compared with an inactive treatment that doesn't use medicine, called a placebo. Taking these drugs for a year can mean a loss of total body weight of 3% to 12% more than that lost with lifestyle changes alone.
Read also: Comprehensive Guide to Weight Loss Doctors
Improved Health Markers: Losing 5% to 10% of your total weight and keeping it off can have important health benefits. 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.
Reduced Cardiovascular Risk: Studies have shown that semaglutides and tirzepatides are not only effective for weight loss, but can also lower cardiovascular risk factors such as blood pressure, cholesterol, and glucose, and can reduce the risk of heart attack, stroke, and cardiovascular death.
Risks and Side Effects
Like all medications, prescription weight-loss drugs come with potential risks and side effects.
Common Side Effects: Mild side effects, such as nausea, constipation and diarrhea, are common. They may lessen over time.
Serious Side Effects: Rarely, serious side effects can happen. That's why it's important to ask your health care provider about all treatment choices.
Drug Interactions: Weight-loss medications may have harmful interactions with other medications you are taking. Discuss any prescribed medications, over-the-counter medications, or herbal products you take. If you are pregnant or planning to become pregnant, you should not take weight-loss medications, as they may harm the fetus.
Weight Regain: Many people gain back some of the weight they lost when they stop taking weight-loss drugs. AOMs may counter the effects of metabolic adaptation and prevent weight regain. After weight reduction, the body metabolically adapts, often causing an increase in hunger hormones and a decrease in satiety hormones and resting metabolic rate, all of which can contribute to weight regain.
Mental Health Considerations: Like all antidepressants, bupropion carries a warning about suicide risk.
Experts are concerned that, in some cases, the side effects of prescription medications that treat overweight and obesity may outweigh the benefits. For this reason, never take a weight management medication only to improve the way you look. Possible side effects vary by medication and how it acts on your body. Most side effects are mild and most often improve if you continue to take the medication.
Important Considerations
Cost and Insurance Coverage: Weight-loss drugs can be expensive and aren't always paid for by insurance. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600.
Treatment Duration: How long you take a weight-loss drug depends on whether the drug helps you lose weight. If you haven't lost at least 5% of your body weight after taking the full dose of a drug for 3 to 6 months, your health care provider will probably change your treatment.
Lifestyle Changes: Medications don’t replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight management medications work best when combined with a lifestyle program. Federal physical activity guidelines recommend at least 150 minutes a week of moderate-intensity aerobic activity and at least 2 days a week of muscle-strengthening activities.
The Role of Healthcare Professionals
Choosing a medication to treat overweight or obesity is a decision between you and your health care professional. Your health care provider thinks about your history and health challenges before choosing a medicine for you.
If you have lost enough weight to improve your health and are not experiencing serious side effects, your health care professional may advise you to stay on the medication indefinitely. If you do not lose at least 5% of your starting weight after 12 weeks on the full dose of your medication, your health care professional will probably advise you to stop taking it.
Raghuveer Vedala, MD, FAAFP, Dipl. ABOM, is a board-certified family medicine and obesity medicine physician currently at Norman Regionals Primary Care South OKC clinic. His commitment to obesity medicine comes from personal and family struggles with obesity, guiding his holistic approach that connects obesity to health issues, including mental health. He promotes wellness through lifestyle changes, emphasizing exercise, healthy eating, and supportive relationships in addition to traditional metric goals. In his free time, Dr. Vedala enjoys traveling with his wife, being a foodie, playing with his dogs, ballroom and Bollywood dancing, karaoke and keeping up with personal fitness.
Addressing Concerns about Compounded Medications
FDA is aware that some patients and health care professionals may look to unapproved versions of GLP-1 (glucagon-like peptide-1 (GLP-1) receptor agonists) drugs, including semaglutide and tirzepatide, as an option for weight loss. This can be risky for patients, as unapproved versions do not undergo FDA’s review for safety, effectiveness and quality before they are marketed.
The agency encourages patients to be vigilant and know the source of their medicine. Carefully check labels of compounded GLP-1 drugs for warning signs such as spelling errors or incorrect addresses and ensure your medicine is provided by a licensed pharmacy and prescribed by a licensed health care provider.
If you receive a product with a licensed pharmacy name on the label that you think might be fraudulent, contact the pharmacy to ask if it is their product. Talk to your doctor if you have questions about your medicines.
The Future of Weight Loss Medications
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026. specifically for obesity. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. Phase 3 results expected soon. at 36 weeks. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. In Phase 2, participants lost up to 24.2% of body weight at 48 weeks. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK). With more options available, doctors will be increasingly able to personalize treatments.
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