How to lose weight when nothing else has worked.

In helping people lose weight, there is a significant gap that needs to be closed. When diet/exercise fails, we need something less invasive  before resorting to surgery with its significant risks and complications. One option is prescription medication.

Collage of Various Types and Colors of Medication

This post has been updated July 22, 2021

On this blog we’ve looked at

how lifestyle changes can make losing weight possible and

which weight loss programs work best.

 But what if those do not work? Studies show that any low fat, low carb , or other restricted calorie diet can lower weight, but then weight tends to plateau and may even rise again.

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.

For some, medication is a good option for weight loss.
For some people, medication is an acceptable option for weight loss.

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Belviq, lorcaserin, a serotonin agonist with uncertain action on appetite; as of September 2020, this has been withdrawn from the market.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. 

an MRI of the human brain
an MRI of the human brain

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-

via Diet Pills, Prescription Weight Loss Drugs, Appetite Suppressants.


exploring the HEART of health

Author: Aletha Cress Oglesby, M.D.

As a family physician, I explore the HEART of HEALTH in my work, recreation, community, and through writing. My blog, Watercress Words, informs and inspires us to live in health. I believe we can turn our health challenges into healthy opportunities. When we do, we can share the HEART of health with our families, communities, and the world. Come explore and share with me.

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