Why weight loss Medicine?
Obesity is a serious disease, and a very complicated one. The causes are not very well understood yet, but we know a lot of the normal physiology is not intact in regard to the hunger, the satiety, and the comfort eating.
The Pathophysiology of the obesity may include impairment in the reward feedback system, the fullness feeling, the fatigue eating, or the depression eating.
There are a lot of medication that has been developed to address some of these abnormalities. I am adding a list of them, how they work and the possible side effects from them.
Like any other disease, when you treat it successfully you don’t stop the medicine and that is why many of these medicines have been approved to be used indefinite as long as the patient needs it.
Phentermine is a stimulant medication that suppresses the appetite. It is approved for short-term use for weight loss in adults with BMI > 30 or those with BMI >27 and health problems such as diabetes. It is FDA-approved for three months’ use only but can be taken intermittently. It ranges from doses of 15mg to 37.5 mg daily. It is recommended that it be taken in the morning to curb the appetite during the day and because it can lead to insomnia due to the stimulant effects. Its use is limited to twelve weeks of continuous use. Patients can develop decreased efficacy with longer continuous use. Phentermine is not safe for use during pregnancy. It should be used while nursing or taking monoamine oxidase inhibitor (MAOI) medications. Patients with glaucoma, current hyperthyroidism, and history of drug abuse should not use this. Relative contraindications include tachycardia (rapid heartbeat), hypertension, and heart disease or arrhythmia (irregular heartbeat) (Kahan2015).
Orlistat is a medication that blocks the absorption of fat from food so that it is not digested. It is approved for long-term use and leads to an average weight loss of 4-6 percent. Side effects include oily/greasy stools, diarrhea, and bowel-movement urgency. However, it has the least side effects or interactions with other medications.
Phentermine/Topiramate ER (Qsymia)
Phentermine/topiramate extended-release formulation is a combination of the weight-loss medicine phentermine and topiramate, a seizure medicine. It produces more weight loss at lower doses than either medicine alone. It is approved for long-term use. There are multiple dosages available that range from 7.5/46 mg to 15/92 mg phentermine/topiramate. Weight loss is 8-10 percent and averages between twenty and twenty four pounds in six months, with the weight loss being maintained for one to two years. Side effects are similar to that of phentermine, with the additional side effects of numbness/tingling, changes in mental function, risk of seizure when discontinued abruptly, and a rare form of glaucoma. Topiramate causes birth defects, and any women on the medication should have a pregnancy test prior to starting the medicine.
Lorcaserin is a serotonin 2c receptor agonist that is specific to the brain and not to receptors on the heart, like previous weight-loss medications. The activation of heart receptors is what caused serious side effects like heart-valve disease and increased risk of heart attack in weight loss medications removed from the market. Lorcaserin works on the brain to increase satiety. It is dosed at 10mg twice daily and is approved for long-term use. Weight loss is 4-6 percent similar to orlistat or phentermine. Side effects include headache, dizziness, and nausea. It can worsen depression in people who are prone to or are currently suffering from depression.
Naltrexone SR/Bupropion SR (Contrave)
Naltrexone/bupropion is a combination of naltrexone, an opioid pain-medicine antagonist, and bupropion, an antidepressant. Weight loss is about 6-8 percent or eight to fifteen pounds. It can lead to high blood pressure and rapid pulse. Other side effects include headache, constipation or diarrhea, dry mouth, and anxiety and worsening depression.
Liraglutide is a glucagon-like peptide-1 (GLP-1) agonist. GLP-a agonists are approved for diabetes treatment, but in December of 2014, liraglutide was approved at 3 mg dose of weight loss. GLP-1 has various actions of which include decreased hunger and early satiety. Weight loss ranges from 6 to 8 percent (eight to eighteen pounds), and the effects last for at least two years. Side effects include nausea, diarrhea, vomiting, and (rarely) pancreatitis.
Weight-loss medications help people lose weight when added to diet and exercise. One should not depend on weight-loss medications alone. Most chronic diseases need combination therapy. Obesity is no different. Lifestyle changes plus medications have been shown to be better than either alone (Wadden et al. 2005). Medications have been shown to improve several health and heart-disease risk factors to varying degrees. Orlistat leads to decreases in blood sugar and blood pressure. Orlistat leads to decreases in blood sugar and blood pressure. Lorcaserin has been shown to help decrease blood pressure and total cholesterol with weight loss, and phentermine/topiramate showed similar effects.
Patients on naltrexone/bupropion and liraglutide showed reductions in blood pressure, blood sugar, and LCL (bad cholesterol). This is important because obesity is linked to the development of diabetes, heart disease, and high cholesterol. When uncontrolled over time, these risk factors lead to increased mortality. There is variability in the response to treatment among the different medications, but with more options available, we can now individualize treatment. Medications are important for short-term weight loss and long-term weight maintenance. Medications helps control hunger and, along with diet and exercise, can have significant impact on one’s health. Although weight loss, not health, may be the primary focus, there are additional benefits to even a small amount of weight loss.