The journey to a healthy body weight is often complex, involving a combination of diet, exercise, and, in some cases, medical interventions. This article explores various aspects of weight loss, drawing on insights from medical professionals, registered dietitians, and the latest research. We'll delve into over-the-counter (OTC) options, prescription medications, weight loss supplements, and essential lifestyle changes, providing a comprehensive guide to achieving and maintaining a healthy weight.
Understanding Weight Loss Medications
When lifestyle changes such as diet and exercise are not enough, weight loss medications can be a viable option. These medications, which range from prescription drugs to over-the-counter options and supplements, are designed to be used in conjunction with permanent lifestyle changes.
Prescription Weight Loss Medications
Prescription medications are intended for long-term use (more than 12 weeks) and must be prescribed by a healthcare provider. They typically work by suppressing appetite or reducing the amount of fat the body absorbs from food. A healthcare professional might recommend medication for those with a body mass index (BMI) of 30 or higher or with a BMI of 27 or higher and a related health condition, such as high blood pressure or insulin resistance. Anti-obesity medications work on the hypothalamus or regulatory center of the brain, helping people burn more calories, feel less hungry, or feel more full and eat less. Some GLP-1 agonists are only FDA-approved for treating Type 2 diabetes, but health care professionals may also prescribe them for weight loss. When a healthcare provider prescribes a medication for use in a way other than its FDA approval, this is called “off-label” use.
Several prescription weight loss medications are available, each with its own mechanism of action and potential side effects:
Xenical (orlistat): Orlistat, available in pill form, prevents the digestion and absorption of fats by enzymes in the stomach and small intestine. This undigested fat is then excreted from the body, reducing calorie absorption. According to Dr. Aliabadi, people can "lose 5% to 10% of their weight over the course of a year" on orlistat. Common side effects include gastrointestinal issues such as fatty or oily stool, increased urgency for bowel movements, and gas. Orlistat can also interfere with the absorption of fat-soluble vitamins (A, D, E, and K), necessitating a daily multivitamin. It is not recommended for individuals with liver or kidney issues, or for those who are pregnant or nursing.
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Qsymia (phentermine-topiramate): This medication combines phentermine, a stimulant and appetite suppressant, with topiramate, an anticonvulsant that also suppresses appetite and enhances feelings of fullness. Phentermine acts as a stimulant (similar to amphetamines) and an appetite suppressant. Topiramate is an anticonvulsant that acts as an appetite suppressant and enhances feelings of fullness. A review found that people with overweight or obesity who took phentermine-topiramate had the greatest likelihood of achieving weight loss of at least 5%. It is not recommended for people with glaucoma, who are pregnant or breastfeeding, who have hyperthyroidism or those taking monoamine oxidase inhibitors.
Contrave (naltrexone-bupropion): Contrave combines naltrexone, used to treat alcohol and opioid use disorder, with bupropion, an antidepressant and smoking cessation aid. Researchers are still determining how the combination medication works on weight loss. One review of four studies found that Contrave was more effective in promoting weight loss when compared with a placebo. It may also increase resting heart rate and blood pressure. The medication is not recommended for people with a history of seizures, bulimia or anorexia nervosa, or those who use opioids.
Saxenda (liraglutide): Saxenda is a form of liraglutide approved for weight loss, while Victoza, another option, is sometimes used off-label. GLP-1 agonists may also increase the risk of developing pancreatitis.
Wegovy (semaglutide): This weekly injection impacts brain hormones to regulate fullness and satisfaction after eating, decreasing hunger and encouraging weight loss. GLP-1 agonists typically cause a weight loss of 5% to 15%, with Wegovy typically performing better than older anti-obesity medications such as Qysmia or Contrave, says Saunders. Side effects are similar to those of Saxenda and other GLP-1 agonists.
IMCIVREE (setmelanotide): This injectable medication is FDA-approved for people 6 and older with obesity caused by three specific, rare genetic conditions. It works by boosting brain receptors to help reduce feelings of hunger, decrease calorie intake, and increase metabolism.
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Ozempic (semaglutide): Although not yet FDA-approved for weight loss, Ozempic is a GLP-1 inhibitor taken as a weekly injection. It makes you feel full and encourages the pancreas to make more insulin.
Trulicity (dulaglutide): This once-weekly injectable prescription medicine improves blood sugar in adults and children 10 years of age and older with Type 2 diabetes and is used off label for weight loss. It's been shown to help people lose weight, especially at a dose of 4.5 mg per week.
BYDUREON BCise (exenatide extended-release): This drug is approved for people with Type 2 diabetes to help them manage blood sugar. Like many of the other medications for Type 2 diabetes with a side effect of weight loss, it is an injectable GLP-1 agonist. Bydureon BCise decreases appetite. As a result, many people with diabetes who use the drug lose weight. In clinical trials, people taking Bydureon BCise lost between 2.2 pounds and 6 pounds on average.
Victoza (liraglutide): Victoza is the same drug as Saxenda except that it is FDA-approved only for the management of blood sugar in people with Type 2 diabetes - and not for weight loss. It is another GLP-1 inhibitor taken as a daily injection.
Mounjaro (tirzepatide): Mounjaro was the first GLP-1 inhibitor to be FDA-approved for the treatment of Type 2 diabetes in May of 2022. However, it wasn't long before researchers determined that otherwise healthy individuals could lose substantial amounts of weight on various doses of the medication. In fact, 85% of the participants in this study lost at least 5% of their body weight.
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Rybelsus: A version of semaglutide is also sold under the brand name Rybelsus as a prescription pill to manage blood sugar for those with Type 2 diabetes. It may help with weight loss but is currently only FDA-approved to treat Type 2 diabetes.
GLP-1 agonists are considered the most effective and safe for treating obesity. Some research has found these drugs can lead to weight loss of anywhere from 10 to 33 pounds when compared with standard weight loss treatment. The most effective anti-obesity medication is the injectable Wegovy, and the most effective medication in pill form is Qsymia, according to Saunders.
The effectiveness of a medication varies based on individual factors such as lifestyle, existing health conditions, and diet. As Manalac notes, "There’s no one-size-fits-all approach to anything in medicine, and weight management is the same."
Over-the-Counter (OTC) Weight Loss Pills
Over-the-counter (OTC) products don't require a prescription from a healthcare provider to purchase them. Someone who doesn’t meet the criteria for a prescription medication might consider trying an OTC option. According to Dr. Thaïs Aliabadi, an OTC medication might work for someone who doesn’t have a significant amount of weight to lose and needs a little extra help on top of a diet and exercise program.
- Orlistat (Alli): Orlistat is sold under the brand name Alli and is FDA-approved for over-the-counter use as a weight loss medication. Orlistat is also sold as a prescription medication under the name of Xenical. The difference between the two is that the prescription contains 120 milligrams and the OTC version contains 60 milligrams. Orlistat works by reducing the amount of fat your body absorbs from the foods you eat. Research has shown orlistat can stop dietary fat absorption by about 30%. If less fat is being absorbed, it could lead to weight loss. The side effects of orlistat include gastrointestinal side effects, such as fatty or oily stool, increased urgency to have a bowel movement and gas. Because orlistat prevents the body from absorbing fat-soluble vitamins (A, D, E and K), they will pass through the body undigested. People with liver or kidney issues that stop the body from absorbing nutrients should not take orlistat. It’s also not recommended for anyone pregnant or nursing. GI side effects and nutrient loss will be less severe if a low-fat diet is chosen. Some experts recommend that anyone on orlistat take a daily multivitamin.
Weight Loss Supplements
Weight loss supplements differ from prescription and OTC medications because they are not considered drugs by the FDA. This classification means supplements are not required to undergo the same review process for approval by the FDA before hitting the market. The FDA may take action to remove unsafe supplements from the market, but it does not regulate them beforehand.
Due to the lack of regulatory oversight, it can be challenging to know what's in dietary supplements, notes Dr. Katherine H. Saunders. In general, there is very little evidence of the effectiveness of weight-loss supplements, although a few studies have been done. “I caution my patients about dietary supplements for weight management because we do not have high-quality data demonstrating efficacy,” adds Saunders. Weight loss supplements may be helpful when used with a healthy diet and exercise regimen.
Here are some common ingredients found in weight loss supplements:
Caffeine: Caffeine works by stimulating the central nervous system and might help with weight loss, but there isn’t enough research to say for certain. Caffeine is regularly ingested in the form of soda, tea, coffee and energy drinks. Foods including chocolate and even some coffee-flavored snacks and energy bars might also contain the stimulant. A variety of dietary supplements and weight-loss pills contain caffeine - sometimes in unexpectedly high doses. It’s generally safe if the dose stays below 400 to 500 mg per day. Side effects can include feeling nervous or jittery, vomiting or rapid heartbeat.
Glucomannan: Glucomannan is a type of dietary fiber that absorbs water. It’s said to increase feelings of fullness, although researchers are not sure if it promotes weight loss.
Green tea extract: Green tea extract contains caffeine and antioxidants, which might help burn fat. It is typically considered safe when drunk in moderate amounts. Green tea extract may cause abdominal pain, nausea, elevated blood pressure, constipation and liver damage.
Green coffee bean extract: Green coffee bean extract might have an effect on body weight and is generally safe to use up to 200 mg per day for up to 12 weeks. “While it’s not the most effective option out there, it may help people with obesity lose weight,” says Manalac.
Raspberry ketones: Raspberry ketone is a compound found in red raspberries and used as an additive in some foods. There isn’t enough evidence to demonstrate that it alone impacts weight loss. In addition, not a lot is known about its long-term safety.
Bitter orange/synephrine: Bitter orange is the name for the plant Citrus aurantium, whose fruit contains p-synephrine, also called synephrine. It was used as a replacement in dietary supplements after the FDA banned ephedra. Although the supplement is widely available online, says Manalac, it is not effective for weight loss and is potentially dangerous.
Meratrim: Metatrim is a weight-loss supplement made with an herbal blend of Sphaeranthus indicus and Garcinia mangostana. One study found the supplement more effective than a placebo in promoting weight loss when used over eight weeks, but the research was funded by the company, which Manalac says could indicate bias.
Garcinia cambogia: Garcinia cambogia, also known as hydroxycitric acid, comes from the pulp and rind of a fruit that grows in Asia, Africa and the Polynesian islands. Despite claims of possible weight loss benefits, there is little research to back it up.
Berberine: Sometimes referred to as "nature's Ozempic," berberine is a naturally occurring plant substance sold in supplements touted as curative for high cholesterol, hypertension and elevated blood sugar. Although previous studies showed a potential weight loss-enhancing benefit for berberine among individuals with preexisting health problems, including polycystic ovarian syndrome and heart disease, other research shows no effect of the supplement on otherwise healthy individuals.
Risks of Over-the-Counter Weight-Loss Supplements
The supplement market is lightly regulated, and weight-loss products may contain hazardous substances, chemical variations of banned substances, and dosages exceeding safe limits. Even if a supplement helps with weight loss, it may not be safe.
Heart Damage: Weight-loss drugs can speed up metabolism and heart rate, potentially damaging the heart muscle.
Increased Stroke Risk: Stimulants in weight-loss supplements can cause the heart to pump faster, increasing the risk of stroke.
Liver Damage: The liver processes supplement ingredients and chemical byproducts, which can cause a build-up of toxic enzymes.
Skin Damage: DNP overdose, though rare, can cause itchy, inflamed skin due to allergic reactions.
Cataracts: Cataracts can develop quickly after DNP use due to changes in blood-cell health and production.
The Role of Diet in Weight Loss
A balanced diet is crucial for achieving and maintaining a healthy weight. Here are some key dietary strategies:
- Eat a Balanced Diet: Include a variety of foods, such as fruits, vegetables, lean proteins, and whole grains.
- Limit Carbohydrate Intake and Increase Protein: Low-carb diets tend to work well, because they tend to be insulin-resistant. Lowering carb content lowers insulin levels, which can help with weight loss. Eat more protein; a diet with 1.5 grams of protein per kilogram of your ideal body weight-about 90 grams of protein a day if your goal is 130 pounds (or about 60 kilograms).
- Focus on Fiber: Getting lots of fiber means you feel fuller for longer on fewer calories. Plus, complex, high-fiber carbs won’t raise your blood sugar (and lead to more food cravings) the same way simple, sugary carbs do. The American Heart Association recommends every woman get at least 21 to 25 grams of fiber per day.
- Add Healthy Fats: Healthy fats can also keep you full, especially if you're trying to keep carbs to a minimum.
- Eat More Fermented Foods Women with PCOS may have less healthy gut bacteria than women without the condition, which may be another reason that they struggle with weight gain. Making efforts to add more healthy bacteria to your system could help.
- Eliminate Added Sugars: Eliminate added sugars because it raises their blood sugar substantially, which then leads to a crash and even worse hunger levels, as well as cravings.
Fruits for Weight Loss
Many people on a weight loss journey heed the advice of dietitians and fill their plates with plenty of fruits. Here are some fruits that are particularly beneficial for weight loss:
- Bananas: Despite being a popular choice, some experts find it surprising that bananas are such a popular choice. Other research suggests bananas may be among the most nutritious fruits to eat, as they offer carbohydrates, vitamins, fiber, fatty acids, and minerals to your diet, and are used in traditional medicine to help manage colds, coughs, ulcers, burns, and diarrhea.
- Blueberries: Dr. Escobar praises blueberries for their antioxidants. Research shows that anthocyanins, particularly in blueberries, helped reduce weight gain in a study of 133,000 men and women. She adds that their low calorie content allows you to enjoy a larger portion size without worrying about stalling your weight loss efforts.
- Strawberries: “Strawberries are another great choice for weight loss - they are perfect to eat by themselves, in a smoothie, on a salad, or with a spoonful of low-sugar whipped cream,” says Escobar. Research shows that eating more potassium, like what is promoted in the Mediterranean diet and the DASH diet, may be a good thing.
- Canned Tomatoes: Escobar says, “Eating fresh fruits is always best, but canned tomatoes can be a great choice, too.” She finds weight-loss-friendly recipes often call for canned tomatoes in forms like tomato paste, tomato sauce, or tomato puree.
- Apples: Escobar encourages her clients to select any kind of fresh apple when they’re on a weight loss journey, and usually tells them to keep portion sizes moderate. Research suggests the vitamins, minerals, and polyphenols found in an apple work together in the body to help fight off chronic diseases like diabetes, obesity, cancer, and cardiovascular diseases.
- Raspberries: Kim Shapira, RD, a nutritional coach at Trimly, declares raspberries a winner for weight loss. Research confirms that fiber helps weight loss by reducing energy intake, body weight, and hunger while increasing satiety.
- Avocados: Research shows that eating avocados affects weight management in ways similar to eating low-fat fruits and vegetables. “Avocado is, all the way around, one of the best foods and the best fats,” Shapira says.
- Watermelon: Shapira describes watermelon as delicious and hydrating, but says that you need to watch the portion size. “Too much watermelon is simply too much and can cause stomach aches and bloating,” she explains. Research shows that eating watermelon has many benefits. One study found that eating 2 cups daily for four weeks made people feel fuller, reduced their desire to eat more, and increased their sense of satisfaction compared to eating low-fat cookies.
Shapira thinks fruit is necessary to include in your diet. “It reduces your risk of so many different diseases, is full of antioxidants and fiber, and tastes delicious.
Exercise and Physical Activity
Regular physical activity is an essential component of a healthy lifestyle and weight management.
- Get Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity exercise per week, or 75 minutes of vigorous-intensity exercise.
- Exercise Before a Meal: Exercising right before a meal can help rev your metabolism so you end up storing more carbs as energy than fat. And working out on the regular trains your body to use up extra glucose stores in your body, which can help keep your insulin levels down.
- Consider Adding Pilates: Pilates is a great way to increase muscle mass and help the body burn calories beyond your workout, which can improve insulin sensitivity and overall muscle tone.
- Get Your Steps In: Logging your steps has major health benefits such as improved heart fitness, blood pressure, and cholesterol, but getting 10,000 steps a day is also a great tool for managing PCOS symptoms and helping with weight loss.
The Importance of Lifestyle
Beyond medications and diet, several lifestyle factors play a significant role in weight management.
- Get Enough Sleep: Aim for 7-9 hours of sleep per night to help your body repair and recharge. Lack of shuteye causes weight to go up because it messes with hormones controlling hunger and fullness.
- Manage Stress: High levels of stress can lead to emotional eating and weight gain. Find ways to manage stress, such as through exercise, meditation, or talking to a therapist.
- Practice Mindful Eating: Sitting down for specified meal times, eating slowly without distractions, and truly savoring your food can help you be more in tune with your hunger levels. It is a simple way to practice portion control and avoid overeating, which helps with weight loss.
- Make Sure You're Eating Enough: Being hyper-focused on dieting and limiting your calories can also lead to overeating later on.
Weight Loss and PCOS
Weight loss can be especially challenging for those living with polycystic ovary syndrome (PCOS). Being overweight is associated with PCOS, per the CDC. Because androgens (hormones that women with PCOS have more of) are linked to insulin resistance, they can cause you to store more fat instead of burning it. That's why some people with PCOS struggle losing weight. Here are some strategies to make weight loss with PCOS less stressful and more manageable:
- Limit your carbohydrate intake and up your protein.
- Focus on fiber.
- Add healthy fats to your plate.
- Eat more fermented foods.
- Eliminate added sugars.
- Consider a supplement.
- If you have sleep issues, don't ignore them.
- Try to find an A+ support system.
- Consider adding Pilates to your workout routine.
- Get your steps in.
- If you're still struggling, ask your doctor about other medication options.
New Year's Resolutions and Weight Loss Medications
As weight-loss medications like Ozempic and Wegovy peak in popularity, experts believe these meds could make it more likely that people stick with their resolutions. Semaglutides are a total game-changer in New Year’s resolutions this year, according to Galit Shokrian, a Los Angeles-based CEO and co-founder of the online weight loss program Trimly. Semaglutide and tyrzepatide treatments are finally allowing overweight women and men to not only lose the weight, but successfully keep it off.
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