Weight Loss: A Journey to A Healthier You!
By: Lynn Pattimakiel, MD • Posted on July 02, 2019
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
- Healthy eating
- Portion control
- Eating until you are only 80% full
- Journaling what you eat
- Using smaller plates
- 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 levels and help with weight loss.
8 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.
- stimulant effects of anxiety
- dry mouth
It is contraindicated in adults with cardiovascular disease, moderate-severe hypertension, cardiac arrhythmias, seizures, hyperthyroidism, glaucoma, or a history of drug abuse. It 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.
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
- decrease anxiety
- paresthesias (nerve irritations)
- taste aversion
- sleepiness, brain fog, and mood impairment
- rarely acute angle glaucoma
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.
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.
- local injection site reactions
It is contraindicated in patients with medullary thyroid carcinoma and MEN type II. Cost may also be prohibitive.
5. Lorcaserin (Belviq®)
Lorcaserin (Belviq®) is a selective serotonin (5HT) receptor agonist that increases satiety via neuronal activation. This is an alternative for patients who are unable to take phentermine, women of child bearing age and may have a beneficial effect in adults with diabetes mellitus.
Side effects reported
- heart failure
- co administration with selective serotonin reuptake inhibitors and bupropion
6. 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.
- mood changes
- neuropsychiatric reactions
- dry mouth
Cost may be prohibitive but the generic versions of bupropion and naltrexone are sometimes separately prescribed.
It is contraindicated in persons with seizure disorders, uncontrolled hypertension, eating disorders, in current alcohol/drug withdrawal or chronic opioid use.
7. 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.
- abdominal pain
- poor absorption of fat soluble vitamins (A,D,E,K)
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!
8. 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.
Greatest side effects reported
- gastrointestinal symptoms such as: diarrhea, constipation, bloating, distension and gas.
There were no major safety risks reported.
- 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.
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 Specialized
Center for Specialized Women’s Health
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