Lifestyle changes like healthy eating and exercise will always be the first-line treatment for overweight and obesity. Medications for obesity are also getting safer and more effective every year.
Your doctor will likely consider factors such as your medical history, any other medications you are taking, and your BMI before prescribing a particular drug. They may also consider the cost, the amount of weight loss required, potential side effects, and the impact it may have. Here are some of your options for obesity treatment medications.
GLP-1 Agonists
GLP-1 agonists work by mimicking the effects of the hormone glucagon-like peptide-1, which your intestines release in response to eating. Glucagon and GLP-1 both signal to your brain that you’ve eaten enough, causing a feeling of fullness. They also slow down your gastrointestinal tract, causing food to stay in your stomach longer, which means you feel full for longer and are less likely to overeat.
The U.S. Food and Drug Administration (FDA) has approved two GLP-1 agonists for weight loss:
- liraglutide (Saxenda)
- semaglutide (Wegovy)
A third approved drug, tirzepatide (Zepbound), is in a similar class. It’s a GLP-1 agonist that also binds to glucose-dependent insulinotropic polypeptide (GIP) receptors and helps your body make insulin.
Saxenda is injected daily, whereas Wegovy (injection) and Zepbound are injected weekly. Wegovy is also now available as an oral tablet taken once daily. Side effects for these medications can include the following:
- Bloating
- Fatigue
- Gas
- Headache
- Heartburn
- Nausea or vomiting
- Diarrhea or constipation
With Wegovy, there are concerns about rare but serious complications, such as thyroid tumors and pancreatitis.
Phentermine
Phentermine is an oral appetite suppressant that’s often combined with the anti-epileptic drug topiramate. The combination of phentermine and topiramate is known as Qsymia; it is approved by the FDA for long-term use and recently became available in a generic form.
Phentermine makes your body release the neurotransmitter norepinephrine, which reduces the sensation of hunger.
Common side effects can include the following:
- Faster heart rate or elevated blood pressure
- Sleeplessness
- Nervousness
- Constipation
Phentermine and topiramate can also increase blood pressure and heart rate, so these need to be monitored. Topiramate can cause serious birth defects and needs to be accompanied by highly reliable birth control in women of childbearing age.
Phentermine alone is not approved for long-term use, but it is typically used long term if an obesity medicine specialist determines that the patient is having a good weight-loss response. Qsymia is FDA-approved for long-term use.
Bupropion-Naltrexone
Bupropion-naltrexone (Contrave) is a combination drug used for weight loss. Bupropion works in the brain to reduce appetite and is also commonly used to treat depression (it is used to help people quit smoking, too). Naltrexone is an FDA-approved treatment for alcohol and opiate addiction, and in general, it should only be used for weight control in combination with bupropion.
Common side effects of Contrave include nausea, dizziness, and changes in bowel habits (diarrhea and constipation).
Bupropion can increase blood pressure and heart rate. You should not take Contrave if you have a seizure disorder, if you take opiate pain medicines, if you have an active eating disorder, or if you have advanced kidney or liver disease. Contrave is FDA-approved for long-term use.
Orlistat
Orlistat, helps your body absorb less fat by blocking the enzyme intestinal lipase, which breaks down fat.
Orlistat is sold as a prescription under the brand name Xenical, but there is a lower-dose, over-the-counter version called Alli. Both come as oral pills. For best results, you should make sure less than 30 percent of the total calories you eat in a day come from fat.
When you take orlistat, the fat that your body didn’t absorb is excreted with your feces. That means a lot of orlistat’s side effects are bowel related:
- Bowel incontinence and an urgent need to go
- Diarrhea or loose stool
- Headache
- Oily or fatty stool
- Oily spotting in your underwear or when you pass gas
- Stomach pain
While orlistat blocks your body’s ability to absorb fat, it also hinders your body’s ability to absorb certain vitamins. Your healthcare provider will probably recommend a multivitamin.
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