Diet Weight Management
It’s Time to Lose Weight

Diet Weight Management and Medications – Most people realize it’s time to lose weight and they are excited about something they have heard or seen in a magazine, book or online. It is normally an honest attempt to kick start a healthier lifestyle. Sometimes when the results aren’t as good as they had hoped they rely more on a medical program. A medical program for weight management is one that takes place in a clinical setting with support from license health care professionals like doctors, nurses, dieticians and therapists. These types of programs offer a holistic approach, combining nutrition and exercise with behavioral therapy, and in some cases, surgical interventions. Participating in this type of program requires a financial commitment, and costs can vary depending on which services are rendered. Sometimes, medical weight loss programs are covered partially or in full by health insurance, especially when weight related conditions like heart disease are present.

Consulting with a Doctor:

A medical weight loss program begins with a consultation with a medical professional who is an expert in obesity and weight loss and management.  The consultation appointment will include gathering a medical history, including previous weight loss attempts, a psychological history, an evaluation for obesity related conditions and causes of obesity, and a general physical exam.

Obesity related conditions that are sometimes revealed during the initials appointments include sleep apnea, abnormal liver tests, thyroid disorders, high cholesterol, and type 2 diabetes.  Based on the findings during the consultation appointment, the doctor may recommend further testing and a plan that may include behavior modification including diet and exercise, a meal replacement plan, and weight loss medications.

Medications for Obesity

Are Obesity Medications Right for Me?

Many people hope that they can just do things the easy way without medications or surgery.  The most effective way to lose weight is by following a nutritious and calorie controlled diet with increased exercise.  In some cases, when diet and exercise alone are not working effectively enough or obesity is extreme or medical conditions need more control, supplementing this method with weight loss medication can be considered.  At this point there are so many options and hopefully plans can be put into motion before things get worse.

Unlike just a few years ago, there are several medications now that are approved by the FDA for weight-loss.  Some are approved for long term use, while others should be taken only for a short time. For long term, or chronic use, orlistat (Xenical® or alli®); naltrexone HCI AND bupropion HCI (CONTRAVE®); phentermine- topiramate ER (Qsymia®); and liraglutide injection (Saxenda®) have FDA approval. Phentermine products (Adipex-P® or Lomaira®) are only approved for short-term use.  Talk with your doctor about the pros and cons of each for your particular needs.

Phentermine (Adipex-P®, Lomaira®)

Phentermine is a prescription medication that comes in the form a pill taken once daily. It acts to decrease appetite by affecting chemicals in the brain. It also acts as a simulant to give extra energy. Because patients can develop a tolerance to it, Phentermine is usually used only for short time periods.  Side effects of phentermine can include elevated blood pressure and heart rate, so it is important to have a doctor monitor your health closely while taking this medication.  It is not appropriate for patients with poorly controlled blood pressure or other heart conditions, glaucoma, stroke, or overactive thyroid.  On phentermine, the typical patient loses 4 to 5 percent of their body weight in one year. That means around ten pounds in a year for a 200 pound person.

Orlistat (Xenical® or alli®)

Orlistat is available under the brand names alli® and Xenical®. Xenical® is the more potent of the two.  Orlistat, at a low dosage, is the only weight-loss medication that is approved by the FDA for over-the-counter availability.  Higher doses require a prescription.  Orlistat comes in capsule form and is most often taken three times daily before meals that contain fat.  Orlistat causes the body to absorb less fat, so that only 66% of caloric intake from fat will be absorbed, and the remaining 33% will be carried away in waste.  On orlistat, patients can expect to lose 5 percent of their body weight in one year, which is about ten pounds for a 200 pound person.  Because orlistat affects fat absorption, it will not work well on those who are already on a low fat diet.  Side effects of orlistat include gastrointestinal issues, and because it can cause some vitamin deficiencies, it should be taken with a multivitamin.

Naltrexone HCI AND Bupropion HCI (CONTRAVE®)

Approved by the FDA in 2014, CONTRAVE® combines several medications – Naltrexone and Bupropion.  Naltrexone is also used to treat drug addiction and alcoholism, and Bupropion is an antidepressant and used to help quit smoking. Together, these two drugs decrease one’s appetite.  After one year on this medication, 65 percent of patients in a study lost 5 percent of more of their body weight, which is a 10 pound loss for a 200 pound person. More than a 1/3 of participants lost 10 percent or more of their weight.  Subjects can also experience improvements in bad cholesterol, good cholesterol, and triglycerides.

Phentermine-Topiramate ER (Qsymia®)

Receiving FDA approval in 2012, phentermine-topiramate combines two drugs. Topiramate is also used to prevent migraines and as a seizure prophylaxis, and weight loss was observed to me a common side effect. Phentermine decreases appetite and increases energy levels.  In a study, a 14.4 percent weight loss was achieved by subjects on the highest dosage of Qsymia®, which is equivalent to losing 29 pounds for a 200 pound person. The highest dose comprises 15 mg phentermine and 92 mg topiramate ER.  Patients on this treatment also experienced improved cholesterol levels.

Liraglutide injection (Saxenda®)

Liraglutide is administered by injection, and received FDA approval in 2014.  It works by increasing insulin production, which regulates blood sugar. Liraglutide also decreases glucagon, a hormone that opposes insulin.  The medication also slows how quickly the stomach empties, and finally, it effects the brain to trigger less eating.  Liraglutide is sometimes used to manage diabetes.
Seventy-three percent of participants taking 3mg daily in a total of four trials lost at least 5 percent of their body weight over one year, equivalent to 10 pounds for a 200 pound person.  Forty-one percent of participants lost at least twice that amount.

Getting On Track

After an initial consultation in a medical weight loss program, patients should make follow-up appointments for opportunities to evaluate progress, ask more questions, and make adjustments if needed.  Initially, follow-up appointments every three to four weeks are beneficial until 5 to 10 percent of one’s body weight is lost.  Once a patient is on a consistent trajectory, visits can be scheduled on an as-needed basis, with periodic follow-ups recommended.

A holistic medical weight loss program including doctors, dieticians and therapists to provided tailored support will produce the most successful results for most individuals. Losing weight can improve or eliminate diseases caused by obesity and drastically improve one’s quality of life.  Even a small amount of weight lost can improve one’s insulin sensitivity, cholesterol and glucose levels, and blood pressure.  Weight lost also reduces the risk of developing heart disease and type 2 diabetes.