Weight-loss drugs: Can a prescription help you lose weight?

Weight-loss drugs can improve your health, if used in combination with a healthy diet and regular exercise. Find out if you could benefit from taking these medications. 

 

It's best to lose weight through a healthy diet and regular exercise. But if you're among those who struggle to lose weight and who have weight-related medical problems, weight-loss drugs may be able to help you.
You should know, however, that weight-loss drugs don't replace the need for changes in your eating habits or activity level. And although weight-loss drugs may sound like every dieter's dream, they aren't appropriate for everyone who's overweight.

Are you a candidate?

Prescription weight-loss drugs aren't intended for people who want to lose just a few pounds for cosmetic reasons. They're 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.
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

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, a typical initial goal for any weight-loss effort. Diet and exercise are responsible for part of this weight loss, and medications are responsible for part as well. It's been estimated that the two drugs approved for long-term use, orlistat (Xenical) and sibutramine (Meridia), can lead to weight loss of 5 to 11 pounds (2.3 to 5 kilograms) above and beyond that produced by diet and exercise alone after one year. 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 if they do work, their effects tend to level off after six months of use. You may need to take weight-loss medication for the rest of your life. When you stop taking these medications, you're likely to regain much or all of the weight you lost.

Most of the older prescription weight-loss drugs approved by the Food and Drug Administration (FDA) are approved for only short-term use — generally less than 12 weeks. Only orlistat and sibutramine have been approved by the FDA for long-term use. Orlistat is also available in a reduced-strength form without a prescription (Alli). Sibutramine and orlistat work in different ways and cause different side effects. Sibutramine changes your brain chemistry, making you feel full more quickly. Orlistat blocks the digestion and absorption of fat in your stomach and intestines. Unabsorbed fat is eliminated in the stool.

The table lists possible side effects for commonly used weight-loss drugs.

Drug	Possible side effects
Diethylpropion (Amfepramone)	Increased blood pressure and heart rate, insomnia, dizziness
Phentermine (adipex, duromine)	Increased blood pressure and heart rate, insomnia, dizziness
Orlistat (Xenical)	Intestinal cramps, gas, oily spotting
Sibutramine (Reductil)	Increased blood pressure and heart rate

 Source: National Institute of Diabetes and Digestive and Kidney Diseases, 2010

Safety of weight-loss drugs

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. With weight-loss drugs, there's an additional factor to consider. The drugs approved for long-term use haven't been around that long, which means that they may have long-term side effects that initial studies didn't uncover. For example, in 2009 the FDA announced it was conducting a safety review of sibutramine, which has been on the market since 1997, because of concerns about increased risk of heart attack and stroke in some people with have a history of heart disease. After reviewing the data, the FDA announced that sibutramine should not to be used in people with heart problems, such as:

• Uncontrolled hypertension
• History of angina or heart attack
• History of stroke or transient ischemic attack
• History of heart arrhythmias
• History of congestive heart failure
• History of peripheral arterial disease

Similarly, the FDA is reviewing the safety of orlistat because of reports of serious liver injury in people taking it. Although no definite association has been established at this time between orlistat and the risk of liver injury, people taking orlistat are advised to be alert to signs and symptoms that could indicate liver injury, such as weakness or fatigue, fever, jaundice, or brown urine. It's possible that the effect on the liver is due to increased weight in people who are using orlistat and not from the medication.

Factors to consider

You and your doctor need to carefully evaluate the potential benefits of taking a drug and weigh them against the possible long-term risks. Cost also is a consideration. Not all health insurance plans cover weight-loss prescription drugs. And some may require prior authorization before covering the expense. If you're unsure of your prescription coverage, contact your health insurance provider.
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. These medications may also help with weight maintenance, especially if you continue exercising regularly. Keeping off the pounds you've lost, however, is an ongoing concern. And many people, despite their efforts, still regain the weight.