Recent stats reveal that about 74% of adults in the U.S. are overweight or obese, with nearly half actively trying to lose weight (1,2). Shedding pounds and maintaining that loss is no small feat. Making lasting healthy lifestyle changes can be challenging, requiring commitment over weeks, months, and even years (3).
Opting for more nutritious foods in the right portions and boosting physical activity are smart choices for both physical and mental health. Losing just 5-10% of your body weight can help lower triglycerides, blood pressure, and blood sugar levels (4). However, even with a healthier lifestyle, some people might find it beneficial to aim for further weight loss (3).
The great news is that several weight loss medications approved by the Food and Drug Administration for long-term use—often called "anti-obesity medications" (AOMs)—can offer some extra support. These medications are designed to be used alongside healthy eating habits and regular physical activity since they don't work effectively on their own (3,4,5,6).
Most of these weight loss medications require a prescription from your doctor. They’re primarily intended for individuals who have already attempted to lose weight through diet and exercise. To qualify, you typically need a BMI of at least 30, or a BMI of at least 27 along with a related health concern, such as diabetes or high blood pressure, where losing additional weight could significantly improve your health (5,7).
These medications aim to help manage weight alongside a nutritious diet and regular physical activity (7). Combining one of these treatments with a healthy lifestyle can enhance weight loss by an additional 3-12% compared to diet and exercise alone (4,7). However, they are not recommended for anyone pregnant, breastfeeding, or trying to conceive (7).
This article offers a quick overview of the pros and cons of weight loss medications, including their benefits, how they work, potential side effects, and essential nutrition strategies to keep in mind while taking them.
What are weight loss medications and how do they work?
There’s a wide range of long-term weight loss medications available, but there isn’t a one-size-fits-all option (5). It’s impossible to know for certain which will work best for you or how effective they will be (5). Having a conversation with your doctor is a great first step. They can help determine the best approach based on your current health, any other medications or supplements you're taking, your family history, and the cost and potential side effects of the medications. Together, you and your doctor can decide on the next steps (4,5).
According to the Obesity Medicine Association, “All weight loss medications work best in the context of a healthy eating plan and exercise” (5). These medications operate through various mechanisms. Most commonly, they help reduce hunger, promote a feeling of fullness faster, and decrease cravings (5,7). They achieve this by interacting with hormones (like leptin and ghrelin), neurotransmitters (such as GABA and serotonin), and peptides (like GLP-1) found in the brain, digestive system, and fat tissue (5,6).
This physiological approach is effective because feeling less hungry, fuller more quickly, and having fewer cravings makes it easier to reduce calorie intake, leading to weight loss (6).
Orlistat, on the other hand, works differently by affecting how the digestive system absorbs fat (7).
Semaglutide, tirzepatide, and liraglutide
Semaglutide and tirzepatide are weekly injections that function as glucagon-like peptide-1 (GLP-1) and GIP receptor agonists (4,5). They work by targeting areas of the brain that regulate appetite and food intake (4,5). Dosages begin low and are gradually increase over 16-20 weeks to help minimize side effects, which can include digestive issues, headaches, dizziness, and fatigue (5).
Liraglutide, on the other hand, is a daily injection that influences gut hormones to promote a feeling of fullness more quickly and reduce hunger (5).
Bupropion-naltrexone
These tablets combine two types of medications: an antidepressant that aids in weight loss and an opioid receptor antagonist that supports alcohol and drug dependence (4,5). When taken together, they affect the pleasure-reward area of the brain, helping you feel fuller more quickly while also reducing appetite and cravings (4,5).
Phentermine and phentermine-topiramate
Phentermine is one of the oldest and most commonly used weight loss medications. It’s a pill that helps reduce appetite, making you feel less hungry (4). When combined with topiramate, which is typically used for seizures and migraines, they work together to further decrease appetite and cravings (5).
Setmelanotide
Setmelanotide is a daily injection designed specifically for individuals with certain rare inherited conditions, like Pro-opiomelanocortin deficiency, proprotein subtilisin-kexin type 1 deficiency, or leptin receptor deficiency (7). Although it doesn’t address the underlying genetic issue, setmelanotide can assist with weight loss by promoting feelings of fullness, reducing appetite, and helping the body burn more calories at rest (7).
Orlistat
Orlistat stands out from other long-term weight loss medications. It's available by prescription, and there's also a lower-strength version that you can buy over the counter (7). Orlistat capsules are taken with meals and work by reducing the body's ability to break down and absorb fat from foods and drinks by ~30% (8). It does this by inhibiting the enzymes that digest fat, so instead of absorbing those calories, the fats pass through the digestive system and are eventually excreted (5).
What are some common side effects of weight loss medications?
While these medications are safe when used as directed, it's important to be aware of potential side effects (6). Most side effects are mild and often improve with continued use (4). Common digestive issues include nausea, constipation, and diarrhea (7,8). Some individuals may also experience dry mouth, abdominal pain, vomiting, headaches, dizziness, nervousness, insomnia, and fatigue (5,7,8). As with any medication, there's a small risk of serious side effects (7).
With orlistat, the unabsorbed fats passing through the digestive tract can lead to side effects like abdominal pain, loose stools, and increased gas (4,7).
A common experience with anti-obesity medications is regaining some of the weight lost after stopping their use (4,5,7,8). This is a natural metabolic response to weight loss, whether achieved through medications or not (5). It’s partly due to a decrease in resting metabolic rate and changes in the hormones that regulate hunger and fullness (5). The Mayo Clinic says, “Practicing healthy lifestyle habits may help limit weight gain” (7).
Staying in touch with your doctor while using any anti-obesity medication is essential. Be sure to reach out if you experience any negative side effects (6). Regular follow-ups can help you share how you're feeling, report any side effects, and track your weight loss progress (7). This information will assist you and your doctor in determining if the medication is effective, if a switch is needed, and when to consider stopping treatment (7).
What nutrition advice is essential when taking weight loss medications?
The most important factor to keep in mind when taking any weight loss medications is to maintain a nutritious eating plan. This means ensuring you get all the essential nutrients and eat the right amounts of food to support your weight loss goals. It’s best to avoid programs that make unrealistic promises (1).
According to the National Institute of Diabetes and Digestive and Kidney Diseases, a safe and effective weight loss program should include “a healthy, reduced-calorie eating and drinking plan, a strategy for increasing physical activity if appropriate, guidance and support for adopting these lifestyle habits, and a plan for maintaining the weight loss” (1).
The goal of an effective weight loss program is to set realistic targets, encourage healthy long-term habits, and offer strategies to track progress and address challenges (1). All these elements should be personalized to your unique situation by a healthcare professional, such as a credentialed registered dietitian.
While there’s no one-size-fits-all weight loss program, here are some key nutritional guidelines to consider as you work toward your goals:
Aim for a realistic weight loss target of about one pound per week (9).
Focus on highly nutritious, filling, fiber-rich foods like fruits, vegetables, and whole grains (9).
When it comes to meat and dairy, opt for leaner cuts and lower-fat options (9).
Minimize less nutritious foods, such as fried items, and those high in sugar or salt (8,9).
Keep portion sizes in check (8,9).
Make water your go-to beverage (9).
Get frequent and regular exercise (9).
Since orlistat works by preventing fat digestion, there are some specific nutrition recommendations to keep in mind. Reducing fat absorption can also decrease the absorption of essential vitamins and minerals, so it’s a good idea to consult your healthcare provider about incorporating a multivitamin or other supplements (8).
Additionally, many of the gastrointestinal side effects can be minimized by following a lower-fat diet while taking Orlistat (5).
According to the Mayo Clinic, “Weight-loss drugs aren't an easy answer to weight loss. But they may help you make the lifestyle changes you need to practice to lose weight and improve your health” (7)
Let Catalyst Support Your Weight Loss Journey
If you’re looking for support in making lifestyle changes that can lead to sustainable weight loss, whether or not you’re using weight loss medications, Catalyst Nutrition and Training’s registered dietitian nutritionists would be happy to help!
We’ve seen the patients in our nutrition counseling program do so well because of all the hard work they put into their approaches. And we’d love to help you, too! We’re located at 480 Pierce St. Suite 201, Kingston, PA, 18704. See us in person or through telehealth!
Ready to start working with a professional who is invested in seeing you thrive, despite weight management challenges? Book an appointment with us today!
References
National Institute of Diabetes and Digestive and Kidney Diseases. (2024, February). Choosing a Safe & Successful Weight-loss Program. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/weight-management/choosing-a-safe-successful-weight-loss-program
National Center for Health Statistics. (2018, July). Attempts to Lose Weight Among Adults in the United States, 2013–2016. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db313.htm
Mayo Clinic (2023, November 1). Weight loss basics. https://www.mayoclinic.org/healthy-lifestyle/weight-loss/basics/weightloss-basics/hlv-20049483
National Institute of Diabetes and Digestive and Kidney Diseases. (2023, March). Prescription Medications to Treat Overweight & Obesity. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity
Obesity Medicine. (2024, January 26). Top Weight Loss Medications. https://obesitymedicine.org/blog/weight-loss-medications/
Cleveland Clinic. (2023, November 20). Appetite Suppressants. https://my.clevelandclinic.org/health/treatments/9463-appetite-suppressants
Mayo Clinic. (2022, October 29). Prescription weight-loss drugs. https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832
Medline Plus. (2023, July 8) Weight-loss medicines. U.S. Department of Health and Human Services, National Institutes of Health. https://medlineplus.gov/ency/patientinstructions/000346.htm
Johns Hopkins Medicine. (n.d.). Medical Nutrition Therapy for Weight Loss. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/medical-nutrition-therapy-for-weight-loss
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