On the journey to a healthy weight, many people struggle to find success with diet and exercise alone. Using weight loss medications can help spur progress. But with a growing selection of weight loss medications available, patients may ask what the strongest or most effective weight loss prescription medication is, and which one is best for them.
Let's debunk some of the fictions surrounding weight loss medications and delve into the facts, safety, and effectiveness of medical weight loss programs.
Weight Loss Medications: Tools, Not Magic
Fiction: Weight loss medications are "magic pills."
Fact: These medications are simply another tool in the toolbox. These medications can be powerful tools, but they do not replace lifestyle and behavioral modifications, including eating a balanced diet, regular exercise, and healthy sleep routines. For long term and sustainable results, other healthy habits have to be developed to go along with the medications.
Healthy eating and exercise are the most recommended ways to lose weight. Medications can help with obesity, but they're not a magic bullet. It's also important to remember that no one drug works for all people.
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Medical weight management is a program to help people lose weight and maintain that weight loss without surgery. This means that medical weight management programs have a big focus on helping you build daily habits for maintaining a healthy lifestyle. Medical weight management is different than dieting on your own because you have a team of experts to offer guidance and support, and to hold you accountable.
Understanding Different Weight Loss Medications
Fiction: All weight loss medications are the same.
Fact: There are a range of medications that have been approved to help patients lose weight, and they work in different ways, have different side effects, and potential benefits. Additionally, people respond in different ways to different medications, based on their genetics, medical history, and lifestyle.
Weight loss medications work in different ways. 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.
Types of weight loss medications include:
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Appetite suppressants: These medications work by impacting the brain's hunger signals to reduce appetite. They help patients lose weight by diminishing hunger cues. Phentermine is the oldest and most widely used weight loss medication. It was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor. Topiramate can be combined with phentermine to decrease appetite and cravings. 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. 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.
Fat absorption inhibitors: These medications block some of the fat that you eat from being absorbed by the body. Your body needs some fat, especially healthy fats found in olive oil, certain fish, and nuts, but most of our diets have too much fat that our body doesn't need. If these unhealthy fats can't be stored, they can't build up around your organs and add to your weight. Orlistat is a lipase inhibitor that comes in a capsule. Undigested fat is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal.
GLP-1 agonists: These medications, which are originally intended for diabetes management, work by controlling blood sugar and increasing the feeling of satiety. These feelings are created by GLP-1 and other fullness hormones, so these medications activate that response more frequently than would occur naturally. GLP-1 agonists are the most effective medications for weight loss. GLP-1 agonists are weight loss medications that cause your stomach to empty more slowly, so you feel full longer. They can also reduce the release of glucagon, a hormone that increases feelings of hunger.
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) 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.
Liraglutide is a daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5-10% of body weight, especially with the higher dose of liraglutide. Liraglutide is also approved for Type 2 Diabetes, under the brand name Victoza. Side effects include nausea, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, fatigue, dizziness, abdominal pain, increased lipase, and renal insufficiency.
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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.
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. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
If you're considering weight loss medications, your healthcare provider will work with you to determine which type of medication would be best for you.
Addressing Safety Concerns
Fiction: Weight loss medications are dangerous.
Fact: Most weight loss medications prescribed by health care providers have undergone rigorous testing by the Food and Drug Administration. When prescribed and taken in the appropriate dosage, they are safe to take.
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.
As with any medication, however, there is the risk of side effects. Common side effects include nausea and diarrhea, but you should talk with your doctor about any side effects or new conditions you observe after you begin taking any medication, including weight loss medications. Additionally, certain compounded medications have not been reviewed by the FDA-talk with your prescribing provider about any concerns about your prescription.
The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems. Older AOMs also have indications based on BMI and may be contraindicated for use with certain other medications.
Around the second dose, we repeat labs, and then do the labs again at six months, once the patient is at the maximum dose.
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% of people. These are things like pancreatitis, cholecystitis, kidney injury and suicidal ideation.
Long-Term Use and Weight Maintenance
Fiction: Once you reach a goal weight you can stop taking medications.
Fact: If the medication is effective and well tolerated, you will need to continue it long-term to maintain your healthier weight. If you stop taking the medication, your body will return to its normal set point and weight regain is the rule, not the exception. This regain usually starts within three months of stopping medication. If your lifestyle has improved substantially and is sustainable, you may still see a slight decrease from your starting weight, up to five percent, after you stop taking medications.
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.
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.
Who is a Candidate for Weight Loss Medications?
Fiction: Anyone can take weight loss medications.
Fact: These medications are generally only approved for and prescribed to patients with a body-mass index (BMI) over 30, or those with a BMI over 27 who have conditions such as diabetes and hypertension. They're not prescribed for minor weight loss or appearance-related purposes. They also may conflict with other medications or health conditions affecting patients. And while some weight loss medications are approved for people under 18, many are not.
For each individual case, the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history. The average weight loss varies from 5% to 21%, with some people losing more and some people losing less. Most people regain weight if AOMs are discontinued. While some weight loss medications are FDA-approved only for adults, some-including semaglutide and liraglutide-are approved for children 12 and older with a BMI >/= 95th percentile.
If someone is on the verge of a medical diagnosis related to weight, it makes sense to treat their obesity pharmaceutically.
Good candidates for medical weight management are those who’ve tried lifestyle changes but struggle to maintain them. Your BMI is a measurement of your body fat based on your height and weight. You can’t have bariatric surgery because of a medical or psychological condition that would make surgery harmful.
The Role of Compounding Pharmacies and FDA Regulations
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.
Compounded drugs should only be used in patients whose medical needs cannot be met by an FDA-approved drug. Patients should obtain a prescription from their doctor and fill the prescription at a state-licensed pharmacy. Visit FDA’s BeSafeRx campaign for resources to safely buy prescription medicines online. Talk to your doctor if you have questions about your medicines.
A compounded drug might be appropriate if a patient’s medical need cannot be met by an FDA-approved drug, or the FDA-approved drug is not commercially available. However, compounded drugs are not FDA approved. This means the agency does not review compounded drugs for safety, effectiveness or quality before they are marketed. The agency has identified some areas of concern for compounded GLP-1 drugs. FDA is working with its state regulatory partners and will continue to communicate with compounders regarding these concerns.
FDA has received complaints that certain compounded GLP-1 drugs have arrived warm or with inadequate ice packs to keep the drug at recommended storage temperatures.
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.
FDA received multiple reports of adverse events, some requiring hospitalization, that may be related to dosing errors associated with compounded injectable semaglutide products.
The agency is aware that some semaglutide products sold by compounders may be the salt forms. These salt forms, including semaglutide sodium and semaglutide acetate, are different active ingredients than are used in the approved drugs. The agency does not have information on whether these salts have the same chemical and pharmacologic properties as the active ingredient in the approved drug, and we are not aware of any lawful basis for their use in compounding.
FDA has received reports of adverse events related to compounded versions of semaglutide and tirzepatide. However, federal law does not require state-licensed pharmacies that are not outsourcing facilities to submit adverse events to FDA so it is likely that adverse events from compounded versions of these drugs are underreported.
FDA monitors the internet for fraudulent or unapproved drugs and has issued warning letters to stop the distribution of illegally marketed semaglutide and tirzepatide. The agency urges consumers to be vigilant when purchasing drugs online and only purchase from state-licensed pharmacies.
The agency urges consumers not to purchase these products which are of unknown quality and may be harmful to their health.
The Importance of a Holistic Approach
Starting any medication as part of a lifestyle change requires informed decision-making and consideration of the pros and cons associated with the medication. If you're wondering if weight loss medications may be right for you, talk with your healthcare provider.
With prescription medications, a healthcare professional can weigh all factors affecting the patient’s lifestyle and BMI and monitor progress and side effects. While no specific vitamin or supplement is considered a “treatment” for obesity or overweight, certain ones help support metabolic health.
All weight loss medications work best in the context of a healthy eating plan and exercise.
Medical weight management is a program to help people lose weight and maintain that weight loss without surgery. This means that medical weight management programs have a big focus on helping you build daily habits for maintaining a healthy lifestyle. Medical weight management is different than dieting on your own because you have a team of experts to offer guidance and support, and to hold you accountable.
You’ll learn about the exercises that will help you achieve and maintain a healthy body weight. Most people will benefit from a combination of cardio, strength training and flexibility exercises.
To lose weight (and keep it off), it’s important to address your attitudes and emotions related to food.