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Weight Loss: A Journey to A Healthier You!

Weight Loss: A Journey to A Healthier You!

By: Lynn Pattimakiel, MD • Posted on July 02, 2019 • Updated June 05, 2023

Obesity Can Lead to Other Medical Concerns

The obesity epidemic is growing and unfortunately, is the root cause and/or worsens many other medical conditions, including:

Instead of only focusing on treating these individual medical conditions, we should actively target to make healthy and sustainable lifestyle modifications to prevent these conditions from arising in the first place by preventing and if needed, treating obesity. This journey is not always an easy one, so it is important to become familiar with all the support services and tools that are available to help achieve and maintain success.

What To Focus On

  1. Healthy eating
  2. Exercise
  3. Portion control
  4. Eating until you are only 80% full
  5. Journaling what you eat
  6. Using smaller plates
  7. Trying to focus on intermittent fasting if you do not have medical conditions to prohibit this.

It is always important to work with your health care clinician and a nutritionist when possible. Some medications prescribed for metabolic reasons, including Glucophage/Metformin® may reduce insulin resistance and help with weight loss.

9 FDA Approved Medications

There are FDA approved medications to help assist in the process of weight loss. Some may be used for short periods of time, while others can be used as a maintenance daily medication. They may act to help control appetite and excessive cravings, block fat, and can have double benefits with other medical conditions like diabetes, migraines and depression. These medications are NOT for everyone, and may have contraindications, therefore it is important to discuss the benefits and possible side effects with your physician.

1. Phentermine (Adipex®)

Phentermine (Adipex®) is a controlled prescription that can be used for up to 3 months at a time in patients with obesity (BMI >= 30) or a BMI > =27 with another co-morbid condition. The medication’s mode of action is a sympathomimetic (norepinephrine) release in the hypothalamus, which helps to reduce hunger. It also inhibits serotonin and dopamine reuptake and may increase energy.

Side effects

  • stimulant effects of anxiety
  • dry mouth
  • constipation
  • palpitations
  • insomnia

Contraindications

It is contraindicated in adults with cardiovascular disease, moderate-severe hypertension, cardiac arrhythmias, seizures, hyperthyroidism, glaucoma, or a history of drug abuse. The Initial prescription requires MONTHLY office visits in order to properly monitor efficacy and side effect profile. It should be discontinued if targeted weight loss is not achieved. Recent updates within the state law allow continuation of phentermine as a daily maintenance medication, if targeted weight loss has been achieved after the initial 3 months. This requires continued office visits every 3 months to monitor safety and efficacy while on therapy.

2. Topiramate (Topamax®)

Topiramate (Topamax®) is a medication that is often used to treat migraines, seizures, and binge eating disorders. It enhances GABA receptor activity and inhibits carbonic anhydrase. Topiramate (Topamax®) may help with the following:

  • excess carbohydrate and soda cravings
  • insomnia
  • decrease anxiety

Side effects

  • paresthesias (nerve irritations)
  • taste aversion
  • sleepiness, brain fog, and mood impairment
  • rarely acute angle glaucoma

Contraindications

Topiramate is contraindicated in persons with glaucoma, renal failure and a history of kidney stones. This medication is teratogenic, therefore should be used with contraception in premenopausal and perimenopausal women and NOT used in women trying to become pregnant.

3. Phentermine/Topiramate CR (Qsymia®)

Phentermine/Topiramate CR (Qsymia®) is an effective FDA approved weight loss medication, with the dual benefit of action of phentermine and topiramate in the convenience of one pill. This medication has been shown to be very effective with a 9% reduction of weight loss compared to placebo. It comes in varying doses and can be titrated up based on tolerability. It can be continued as a daily maintenance medication.

Contraindications

It carries similar contraindications and side effect profiles as the individual components. This prescription may be cost prohibitive due to its expense.

4. Liraglutide (Saxenda®)

Liraglutide (Saxenda®) is a human GLP-1 receptor agonist which has the double benefit of treating diabetes. It helps reduce hunger and cravings, and is associated with a reduction of cardiovascular events.

Side effects

  • local injection site reactions
  • nausea
  • gastroparesis
  • pancreatitis
  • Gall bladder disease

Contraindications

It is contraindicated in patients with medullary thyroid carcinoma and MEN type II. Cost may also be prohibitive.

5. Naltrexone-Bupropion XR (Contrave®)

Naltrexone-Bupropion XR (Contrave®) is a combination of weak dopamine agonist and norepinephrine reuptake inhibitor and opioid receptor agonist. It helps with excessive cravings and hedonistic food drive. It may have a double benefit with smoking and alcohol cessation.

Side effects

  • mood changes
  • neuropsychiatric reactions
  • nausea
  • headache
  • insomnia
  • dizziness
  • dry mouth

Cost may be prohibitive but the generic versions of bupropion and naltrexone are sometimes separately prescribed.

Contraindications

It is contraindicated in persons with seizure disorders, uncontrolled hypertension, eating disorders, in current alcohol/drug withdrawal or chronic opioid use.

6. Orlistat (Xenical®/Alli®)

Orlistat (Xenical®/Alli®) is a lipase inhibitor which blocks approximately 30% of fat intake. It may be beneficial in adults with elevated triglyceride levels and patients with constipation.

Side effects

  • flatulence
  • diarrhea
  • bloating
  • abdominal pain
  • poor absorption of fat soluble vitamins (A,D,E,K)

Contraindications

It is contraindicated in patients with malabsorption disorders, liver disease and kidney stones. Cost may be prohibitive. However, Alli® can now be purchased over the counter. If you try this weight loss agent and have liquid orange stools, it means you are ingesting too many fat grams!

7. Superabsorbent Hydrogel Particles in Capsules (Plenity®)

Superabsorbent Hydrogel Particles in Capsules (Plenity®), is the latest FDA cleared weight management device that targets overweight to obese patients with a BMI of 25-40. Plenity® is a superabsorbent hydrogel capsule composed of modified cellulose and citric acid that creates a 3-D matrix. It is taken 30 minutes before lunch and dinner with water, and once reaching the stomach, will expand to occupy approximately 1/4th of the stomach volume, as thousands of small gel pieces. It is not a medication or stimulate, rather it is a GI device. Plenity® maintains the 3D matrix structure as it travels through the small intestine, and begins to be broken down by enzymes in the large intestine. This material is then expelled in stool. The results seen in the Gelesis Loss of Weight (GLOW) study showed greater weight loss compared to placebo (6.4% vs 4.4%) with the treated group having twice the odds of reaching >=5% and >= 10% weight loss.

Side effects

  • gastrointestinal symptoms such as: diarrhea, constipation, bloating, distension and gas.

There were no major safety risks reported.

Contraindications

  • pregnancy
  • gastrointestinal disorders
  • history of gastric bypass or other gastric/esophageal surgeries

It is important to note that patients that participated in this study also followed a lower calorie diet and a daily moderate-intensity exercise regimen. Patients were only followed for a 6 month period, so long term results have not been determined.

8. Wegovy® (semaglutide)

Wegovy® is one of the newer injectable weight loss medications. In June 2021, the FDA approved semaglutide (Wegovy™) 2.4 mg injection under the skin once weekly for chronic weight management in adults with obesity or overweight with at least one health condition (e.g., high blood pressure, high cholesterol, type 2 diabetes mellitus, or obstructive sleep apnea) in addition to participating in a weight management program.

Side effects

    • Gastrointestinal symptoms including nausea, vomiting, diarrhea, constipation, abdominal pain, abdominal distension, gastroenteritis (intestinal infection), belching, flatulence, or indigestion/ gastrointestinal reflux disease
    • Headache
    • Fatigue
    • Hypoglycemia (low blood sugar)
    • Gall bladder disease
    • Gastroparesis
    • Pancreatitis

Contraindications

    1. Patients with a personal or family history of medullary thyroid carcinoma should not use Wegovy™ because there is a potential risk for thyroid C-cell tumors.
    2. Patients with multiple endocrine neoplasia syndrome type 2 (MEN-2) should avoid Wegovy™.

9. Mounjaro® (tirzepatide)

Mounjaro® is another newer injectable weight loss medications. In May 2022, the U.S. Food and Drug Administration (FDA) approved Mounjaro (tirzepatide) injection. While not yet approved for weight loss, Mounjaro was granted fast track speedy review by the FDA in October 2022, and Eli Lilly & Co. is actively submitting weight loss data to gain the indication by 2023.

It is important to note that there is not one magic diet, medication, or surgery that will be the answer for everyone in the fight against obesity. In order to achieve sustainable results, we need to focus on implementing healthy life style changes that we can realistically follow on a daily basis going forward. Luckily, we have a growing arsenal of tools that can be utilized to support you in your weight loss journey.

Visit a local health care clinician and if needed a weight management specialist to help guide you on a path to a healthier you!

Be Strong. Be Healthy. Be in Charge!

-Lynn Pattimakiel, MD
Women’s Health Specialist
Center for Specialized Women’s Health
Cleveland Clinic

About Lynn Pattimakiel, MD

Lynn Pattimakiel, MD is a board certified internist, currently working as staff at the Cleveland Clinic main campus and Center for Specialized Women’s Health. She received her M.D. from the University of Debrecen, Hungary, and completed her residency training in Internal Medicine at St. Vincent Charity Hospital in Cleveland. She completed a 2 year fellowship in Women’s Health at the Cleveland Clinic. She is a certified menopause practitioner. Her special interests include menopause, hormone therapy, osteoporosis and female sexual dysfunction. She helps to lecture and supervise medical residents in their clinical activity.

In the Center for Specialized Women’s Health, we pursue leading edge therapies for women. There are several new FDA approved pelvic floor stimulators that are available for women with urine leakage and pelvic muscle weakness as well as fecal incontinence and mild degrees of pelvic organ prolapse. These new pelvic floor stimulation devices are custom-fit and use stimulation to strengthen pelvic floor muscles and inhibit overactive bladder muscles while giving visual biofeedback and audible guidance. Precise adjustments can be made to ensure effective muscle training. Some women, who have only stress urinary leakage, and/or are 6 weeks post partum from vaginal delivery, may need simpler devices and all therapies can be done in the comfort and privacy of ones home. These devices can compliment, or in many cases be used instead of surgery or medications.

women's health, weight loss, weight loss medications, exercise, dr. lynn pattimakiel

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