Prescription weight-loss drugs: Can they help you?

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Prescription weight-loss drugs: Can they help you?

If you have serious health problems because of your weight and dieting hasn't worked for you, prescription weight-loss drugs may be an option. You should know, though, that prescription weight-loss drugs don't replace the need to make healthy changes in your eating habits and activity level.

Who is a candidate for weight-loss drugs?

Prescription weight-loss drugs are generally reserved for people who haven't been able to lose weight through diet and exercise, and who have health problems because of their weight. They're not for people who want to lose just a few pounds for cosmetic reasons.

Your doctor may consider weight-loss drugs for you if you have no contraindications and:

  • Your body mass index (BMI) is greater than 30
  • Your BMI is greater than 27 and you have a serious medical problem related to obesity, such as diabetes or high blood pressure

Before selecting a medication for you, your doctor will consider your health history, possible side effects and potential interaction of weight-loss drugs with other medications you're taking.

How well do weight-loss drugs work?

When combined with a low-calorie diet and regular exercise, weight-loss drugs produce an average weight loss of 5 to 10 percent of total body weight within a year, which is a typical weight-loss goal. Diet and exercise are responsible for part of this weight loss, and medications are responsible for part as well.

Losing 5 to 10 percent of your total weight may not seem like much, but even modest weight loss can improve your health by:

  • Decreasing blood pressure
  • Decreasing lipid levels
  • Decreasing blood glucose levels
  • Increasing insulin sensitivity

It's important to keep in mind, however, that these medications may not work for everyone. And when you stop taking these medications, you're likely to regain much or all of the weight you lost.

Common weight-loss drugs

Diethylpropion (Tenuate) and phentermine (Adipex) are approved by the Food and Drug Administration (FDA) for only short-term use — generally less than 12 weeks. Orlistat (Xenical), lorcaserin (Belviq) and a combination drug (Qsymia) are approved by the FDA for long-term use. Qsymia contains phentermine and an extended-release (ER) form of topiramate. Orlistat is also available in a reduced-strength form without a prescription (Alli).

The chart shows the commonly used prescription weight-loss drugs, how they work and their side effects.

DrugMechanism of actionPossible side effects
Diethylpropion (Tenuate) Decreases appetite, increases feeling of fullness Increased blood pressure and heart rate, insomnia, dizziness
Lorcaserin (Belviq) Decreases appetite, increases feeling of fullness Headache, dizziness, fatigue, nausea, dry mouth, constipation
Phentermine (Adipex) Decreases appetite, increases feeling of fullness Increased blood pressure and heart rate, insomnia, dizziness
Orlistat (Xenical) Blocks absorption of fat Intestinal cramps, gas, diarrhea, oily spotting
Phentermine and extended-release topiramate (Qsymia) Decreases appetite, increases feeling of fullness Increased heart rate, birth defects, tingling of hands and feet, insomnia, dizziness, constipation, dry mouth

Safety of weight-loss drugs

Safety has been a concern with some weight-loss medications. For example, sibutramine (Meridia) was approved in 1997 for weight loss but was removed from the market in 2010 because follow-up studies showed an increase in the risk of serious heart events, including nonfatal heart attack and stroke.

In the same year, the FDA conducted a safety review of orlistat because of rare reports of serious liver injury in people taking it. No cause and effect relationship was established between orlistat and the risk of liver injury. However, Xenical and Alli labels now advise people taking orlistat to be alert to signs and symptoms that could indicate liver injury, such as itching, loss of appetite, yellow eyes or skin, light-colored stool, or brown urine.

Belviq and Qsymia were originally rejected by the FDA, but the manufacturers subsequently provided additional data that lead to approval.

Belviq raised concerns because it works somewhat like fenfluramine — which was withdrawn from the market because it damaged heart valves. However, there is no evidence that Belviq damages heart valves.

Qsymia increases the risk of birth defects. Thus, the FDA required the manufacturer to have a risk evaluation and mitigation strategy (REMS). The REMS is intended to alert women to the risks and explain the need to avoid becoming pregnant while taking Qsymia.

With any new drug, it's important to keep in mind that concerns or side effects not seen in the initial trials may come to light as more people use the drugs.

Factors to consider

If you meet the criteria for prescription weight-loss drugs, you and your doctor will need to evaluate the potential benefits against the possible risks of taking the medicine. Cost also is a consideration. Not all health insurance plans cover prescription weight-loss drugs.

As you consider weight-loss drugs, make sure that you make every effort to exercise, change your eating habits and adjust any other lifestyle factors that have contributed to your excess weight.

Weight-loss drugs aren't the easy answer to weight loss, but they can be a useful tool to help you make the necessary diet and lifestyle changes. Keeping off the pounds you've lost, however, is an ongoing concern. And many people, despite their efforts, still regain the weight.

Last Updated: 2012-07-27
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