This post has been updated July 22, 2021
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For severely overweight people, especially with a BMI of 30 or more, this means that even if they lose weight, they still have not reached a healthy weight. For them, some type of weight loss (bariatric) surgery may be considered.
One option is prescription medication. Prescribing drugs for weight loss is not new, and has been an approach used by some retail weight loss clinics, “weight doctors”, for years.
Most of these programs used stimulant type drugs, amphetamines, to decrease appetite. People do lose weight on these because they eat less, but the drugs’ effect tends to diminish with time. They also have high potential for abuse and dependence.
When the non-amphetamine drug Meridia (sibutramine) was released, we thought we had found the solution- an effective drug without the risk and side effects. of amphetamines. However, once a significant risk of serious cardiac effects was found, its use was suspended.
Another drug, orlistat, seemed promising. Known by the brand names of Xenical and Alli, it works in the gut to block the absorption of fat. But patients found the unpleasant side effects of gas, diarrhea and oily stools not worth the benefit.
In past few years several new drugs have come to the party.
Belviq, lorcaserin, a serotonin agonist with uncertain action on appetite; as of September 2020, this has been withdrawn from the market.
Qysmia, a combination of two drugs- phentermine/topiramate,a stimulant and an antiseizure drug,
Contrave, also a combo -naltrexone, used for alcohol dependence and bupropion, an antidepressant
Saxenda, liraglutide; unique in that it is taken by subcutaneous (SC) injection similar to insulin; it also is used for diabetes under the name Victoza
Wegovy, semaglutide, also a subcutaneous injection, given just once weekly, rather than daily like Saxendra
Please note: none of these drugs are approved for use in pregnancy, and are in fact contraindicated, meaning they are unsafe in pregnancy and probably unsafe while breastfeeding.
These drugs all work in the brain to control appetite and increase satiety, the feeling of fullness. The long term solution to preventing and reversing obesity may lie in finding new ways to control the processes in the brain that control eating behavior. Much of obesity management research is directed to this area.
Learn more about the use and side effects of these drugs here-