When should weight loss medications or surgery be used?
Although medications for weight loss are available, they should only be used by people who have health risks related to being obese. Doctors usually consider medications to be an appropriate treatment in patients with a BMI greater than 30 or in those with a BMI of greater than 27 who have other medical conditions (such as high blood pressure, diabetes, and high blood cholesterol) that put them at risk for developing heart disease who have been unable to achieve doctor prescribed weight loss goals with lifestyle changes. It is not recommended that medications be used for cosmetic weight loss or to lose small amounts of weight.
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All weight loss medications are designed to be used along with a nutritious diet, exercise, and healthy lifestyle changes. Drugs used to assist with weight loss include:
Orlistat (Alli [available over-the-counter OTC], Xenical [available by prescription])
Inhibits pancreatic lipases which alter fat digestion so fat is eliminated in feces
Can prevent the absorption of about 25% to 30% of calories from fat in the diet.
GLP-1 receptor agonists and GLP-1/GIP drugs:
In addition to helping with weight loss, these drugs have positive effects on blood sugar, which may play a role in how they work for weight loss.
The preferred medication for patients with type 2 diabetes, especially those with heart problems.
Slow the movement of food through the stomach which may cause people to feel full more quickly when eating, thus resulting in eating less.
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Activates receptors of hormones involved in food digestion in the small intestine to make the body feel full.
Semaglutide (Ozempic, Wegovy, Rybelsus)
Liraglutide (Saxenda, Victoza).
Tirzepatide (Mounjaro, Zepbound).
Combination drugs:
Phentermine-topiramate (extended-release) (Qsymia).
Used in obese men and postmenopausal women who do not have high blood pressure (hypertension) or coronary heart disease
The combination of these drugs boosts weight loss in the first year of use
Naltrexone-bupropion (sustained release) (Contrave).
Produces similar weight loss similar to orlistat, but has more side effects, Not usually recommended as first-line drug therapy, but may be used for obese smokers who want to quit smoking and treat obesity.
Sympathomimetic drugs used for weight loss include:
Phentermine (Adipex-P, Lomaira),
benzphetamine, phendimetrazine, and diethylpropion
Only approved for short-term (12 weeks) use, because they have more side effects and have the potential for abuse
Not recommended for use in patients with coronary heart disease, uncontrolled high blood pressure (hypertension), hyperthyroidism, or in patients with a history of drug abuse.
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Weight loss surgery, which includes procedures such as laparoscopic adjustable gastric banding (LAGB), gastric sleeve surgery (sleeve gastrectomy), and gastric bypass is also available for people with severe obesity whose attempts to lose weight through other medical treatment methods have failed. Most experts agree that bariatric surgery, or surgery to promote weight loss, should be reserved for the morbidly obese (those who have a BMI greater than 40) or those with a BMI of 35 to 40 with obesity related health problems like cardiovascular disease, diabetes mellitus, hypertension, or severe sleep apnea.
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