Obesity and overweight affect increasing numbers of people, and for some, diet and exercise aren’t enough. A broad range of drug interventions can help.
Who Can Take Obesity Drugs, and Who Shouldn’t?
While weight loss medications can be effective in aiding weight loss, they are typically prescribed only in cases of obesity or overweight that can lead to severe health problems.
“The clinician can review and follow several published guidelines that have summarized best evidence of when to initiate pharmacologic therapies,” Mary Ann Kliethermes, who holds a doctorate in pharmacy and is the director of medication safety and quality for the American Society of Health-Systems Pharmacists, told The Epoch Times.
The American Gastroenterological Association (AGA) recommends using drug therapy when lifestyle modifications have failed or shown insufficient results, and the patient has weight-related complications, like diabetes, hypertension, or high cholesterol.
“It is inappropriate for people taking these classes of medications purely for cosmetic reasons,” said Dr. Amanda Velazquez, director of obesity medicine in the Department of Surgery at Cedars-Sinai Hospital.
“This is feeding into our societal obsession with ‘thinness,’ and that’s not productive, especially when it comes to health,” she continued.
2 Common Types of Weight Loss Drugs
Weight loss drugs that are currently available include:
Fat Absorption Inhibitors
Orlistat is a fat absorption inhibitor that reduces our ability to absorb fat in the intestines. It inhibits an enzyme called lipase, which breaks down fat molecules. This prevents the body from absorbing and storing dietary fats.
Side effects of using Orlistat can include bladder pain, ear congestion, and muscle aches.
Appetite suppressants work by reducing hunger and promoting feelings of fullness.
These drugs work by increasing levels of certain brain chemicals, such as serotonin and norepinephrine, that control hunger and satiety. Some of the most commonly used appetite suppressants include phentermine, diethylpropion, and benzphetamine.
Side effects of these medications can include insomnia, dry mouth, and constipation.
An appetite suppressant recently approved by the U.S. Food and Drug Administration (FDA) is a semaglutide sold under the brand name Wegovy. Injected once per week, it works by mimicking the hormone glucagon-like peptide-1 (GLP-1), which targets areas of the brain regulating appetite and food intake.
The most common side effects of Wegovy include nausea, diarrhea, vomiting, and constipation.
Another GLP-1 inhibitor called tirzepatide helps you reduce food intake while blunting metabolic responses that usually occur with calorie restriction, like slowed metabolism. A common side effect of tirzepatide is stomach pain; less common ones include fast heartbeat, heartburn, and recurrent fever.
Other GLP-1 inhibitors include Saxenda, also called liraglutide (pdf).
Certain classes of weight loss medications, like the GLP1 agonists, offer other health benefits, including improved insulin sensitivity, fatty liver, cardiovascular outcomes, and kidney health.
Possible Severe Side Effects and ‘Lifelong’ Treatment
However, tirzepatide and Wegovy are also associated with a potentially severe side effect.
“Both semaglutide and liraglutide have boxed warnings for multiple endocrine neoplasia type 2 syndrome,” said Kliethermes.
The FDA warns that Saxenda causes thyroid tumors at “clinically relevant exposures” in rats. “It is unknown whether Saxenda causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans,” cautioned the FDA.
These drugs are also intended to be taken lifelong to maintain weight loss.
“This is because obesity is a chronic, complex medical condition, just like high blood pressure and diabetes. Thus, we treat it similarly—lifelong,” said Velazquez.
These drugs aren’t magic bullets.
“It is important for everyone to understand that all medications have a benefit and a risk,” said Kliethermes. Before using them, doctors also need to consider individually whether patients have other medical conditions, other medications, and the cost.
These drugs are typically prescribed together with lifestyle changes, like eating a healthy diet and getting regular exercise.
Natural Metabolism Boosters
Metabolism boosters work by increasing the metabolic rate of the body and thus stimulate the body to burn more calories than it normally would.
Natural metabolism boosters include:
Ephedrine: A systematic review of studies concluded that ephedrine, found in Ma Huang, an herb used in traditional Chinese medicine, is linked to weight loss and increased energy.
Caffeine: This compound gives coffee its reputation as an energy booster. Research finds people who successfully maintained weight loss consumed “significantly” more cups of coffee and caffeinated beverages compared with a control group.
Green tea extract: A randomized, controlled trial found green tea enhanced fat burning during exercise, and a systematic review of studies concluded that green tea extract can help improve glucose metabolism and facilitate weight loss.
Exercise: It’s obvious that the more you move, the more calories you’ll burn. Research confirms that combining weight training with diet reduces body fat while maintaining calorie-burning muscle mass.
For those who don’t have the time for a formal training regimen, one study finds that just walking (at any speed) reduces total body fat.