Prescription diet medications: The risks and benefits
by Lucy Maher
If you’re looking to drop a few pounds, you’re in good company. That’s because almost half of Americans each year try to lose weight.
But for the 93 million Americans who are considered obese, or those who have a body mass index of 30 or higher, losing weight means more than just dropping a dress size. Their concerns include lowering their risk of heart disease, stroke, type 2 diabetes, and even some types of cancer.
And while many will change their eating habits and exercise more to shed the weight, some will also use prescription diet medications called anti-obesity medications (AOMs) to speed up the process.
“There are several safe and effective FDA-approved AOMs,” says Dr. Ethan Lazarus, MD, a weight-loss doctor at Clinical Nutrition Center in Greenwood Village, Colorado. “Most work by decreasing hunger and/or improving the satisfaction we get when we eat. For a person trying hard to stick with a healthy eating plan, the medications help improve the odds of successful weight loss because the individual has less hunger and improved satisfaction, or fullness, from food.”
To qualify, a patient must have a BMI of 30 or greater, or, says Dr. Lazarus, if the BMI is 27 or greater and there is another significant weight-related health issues such as type 2 diabetes, hypertension, or high cholesterol. For those individuals, these medications can help keep weight off in the long-term. There are currently five available for long-term use:
How Anti-Obesity Medications Are Beneficial
Ask anyone who has tried to lose weight and they will likely say it’s a struggle. AOMs make the journey a little easier.
On average, according to the National Institute of Diabetes and Digestive and Kidney Diseases, those who take AOMs and follow a supervised lifestyle program lose between 3-9% more of their starting body weight than those who only participate in the lifestyle program. Researchers have also found that some patients taking AOMs can lose 10% or more of their starting weight.
For folks who are obese, dropping 5 to 10% of one’s body weight can result in lowered blood sugar, blood pressure, and triglycerides. Other health problems related to obesity and excess pounds, such as joint pain or sleep apnea, can also be alleviated. When taking AOMs, most weight loss occurs in six months.
“All of the medications double-to-triple the odds of losing at least 5-10% of one’s body weight,” says Dr. Lazarus. “So, for an individual who weighs 200 pounds, the medications would double-to-triple the odds of getting the weight down to 180 pounds.”
More importantly, he continues, the drugs “significantly enhance the odds of keeping the weight off. Anybody who has lost weight will tell you that losing it is nowhere near as hard as keeping the weight off.”
The Side Effects To Be Aware Of
From dizziness and nausea to insomnia, there are numerous issues one might experience when taking an AOM.
“Most [AOMs] are very well-tolerated,” says Dr. Lazarus, “but there are some side effects to watch for. Generally, side effects are mild and tend to go away as people get used to the medication.”
According to Dr. Lazarus, they include:
Phentermine: Dry mouth, anxiety, elevation in blood pressure, insomnia, increase in energy
Contrave: Nausea and vomiting, constipation, anxiety, headache, insomnia
Belviq: Dizziness, headache, fatigue
Saxenda: Nausea and vomiting, constipation, diarrhea
Qsymia: Dry mouth, anxiety, elevation in blood pressure, insomnia, increase in energy, tingling in hands and feet, bad taste in mouth with carbonated beverages, cognitive side effects. This drug can cause birth defects if a patient becomes pregnant.
While to many, AOMs might sound like a panacea, Dr. David Gortler, a professor of pharmacology at Georgetown University School of Medicine, and a former FDA official who is an expert in drug safety and FDA regulatory affairs, says “there is no ‘silver bullet’ which will magically burn fat. Any FDA-approved weight loss therapy must accommodate reasonable exercising and dietary changes. The pharmacology we have developed at this point just adds a little bit of an extra push to assist.”
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