Obesity often requires long-term treatment to promote and sustain weight loss. As in other chronic conditions, such as diabetes or high blood pressure, use of prescription drugs may be appropriate for some people. While most side effects of prescription weight loss drugs are mild, serious complications have been reported. More on that below.
Keep in mind that these drugs are not a cure-all for obesity. The use of weight loss drugs should be combined with physical activity and improved diet to lose and maintain weight successfully over the long term.
Do I Need a Prescription Weight Loss Drug?
Using prescription weight loss drugs to treat obesity should be used as an option for the following individuals:
People with a body mass index(BMI) of 30 and above with no obesity-related conditions.
A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure.
Types of Prescription Weight Loss Drugs
Currently, most available weight loss drugs approved by the FDA are for short-term use, meaning a few weeks or months.
Most available weight-loss medications are "appetite suppressants." These drugs generally come in the form of tablets or extended-release capsules (pills that release medication over a long period of time). Appetite suppressants can be obtained by a doctor's prescription or purchased over the counter. One common appetite suppressant is Meridia.
In the mid-1990s, doctors also prescribed the popular appetite suppressant Redux or the combination of phentermine and fenfluramine, called "phen-fen." However, fenfluramine (Pondimin) and Redux were withdrawn from the market in 1997 because they caused damage to heart valves. Phentermine is still available by prescription. Taking phentermine alone has not been associated with the adverse health effects of the phen-fen combination.
Another type of prescription weight loss drug is a fat absorption inhibitor. Xenical is the only example of this type of treatment approved for use in the U.S. Xenical works by blocking about 30% of dietary fat from being absorbed. Xenical is now sold over-the-counter as Alli.
Meridia and Xenical are the only weight loss drugs approved for longer-term use in significantly obese people, although the safety and effectiveness have not been established for use beyond two years.
Newer drugs are being studied as potential treatments for obesity, some of which are showing promise and may be available in the near future.
How Do Appetite Suppressants Cause Weight Loss?
Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that it is full. They decrease appetite by increasing serotonin or catecholamine -- two brain chemicals that affect mood and appetite.
How Do Fat Absorption Inhibitors Cause Weight Loss?
Fat absorption inhibitors work by preventing your body from breaking down and absorbing fat eaten with your meals. This unabsorbed fat is eliminated in bowel movements.
Do Prescription Weight Loss Drugs Really Work?
In general, Xenical and Meridia are moderately effective, leading to an average weight loss of 5 to 22 pounds over a one-year period, more than what would be expected with non-drug treatments. However, the response to these drugs is based on each individual, and some people experience more weight loss than others. Likewise, there is no one correct dose for these medications. Your doctor will decide what works best for you based on his or her evaluation of your medical condition and your response to treatment. Patients generally experience a maximum weight loss within six months of starting medication treatment.
Over the short term, weight loss from prescription drugs may reduce a number of health risks in obese people. However, there are currently no studies to determine the effects of these medications over the long term.
The Risks of Prescription Weight Loss Drugs
When considering long-term weight loss drugs for obesity, the following possible concerns and risks should be discussed with your doctor:
Addiction . Currently, all prescription obesity drugs except Xenical are "controlled substances." This means that doctors are required to follow certain restrictions when prescribing them since they could be addictive.
Developed tolerance. Most people's weight tends to level off after six months while taking a weight-loss medication. This leads to a concern that the person has developed a tolerance for the medication. However, it is unclear whether this leveling off is indeed due to a developed tolerance or if the drug has reached its limit in effectiveness.
Side effects. Most side effects of weight loss drugs are mild (although some can be unpleasant) and usually improve as your body adjusts to the medication. Rarely, serious and even fatal outcomes have been reported.
The Side Effects of Prescription Weight Loss Drugs
Most appetite suppressants are used as a short-term treatment for obese people. Not only do the drugs' effects tend to wear off after a few weeks, but they can also have some unpleasant side effects, including:
Increased heart rate
Increased blood pressure
Sweating
Constipation
Insomnia (inability to sleep or stay asleep)
Excessive thirst
Lightheadedness
Drowsiness
Stuffy nose
Headache
Anxiety
Dry mouth
Some side effects with Xenical include abdominal cramping, passing gas, leakage of oily stool, increased number of bowel movements, and the inability to control bowel movements. These side effects are generally mild and temporary, but may be worsened by eating foods that are high in fat. Patients should eat a low-fat diet (less than 30% of calories from fat) before starting treatment with Xenical. Because Xenical reduces the absorption of some vitamins, people taking Xenical should take a multivitamin at least two hours before or after taking the medication.
People with poorly controlled high blood pressure, heart disease, irregular heartbeat, or a history of stroke should not take Meridia. All people taking Meridia should have their blood pressure and heart rate monitored on a regular basis.
Because these drugs are not recommended for long-term use, it is important for people who are trying to lose weight to learn new eating habits and to exercise while the drug is still effective. Once healthy eating and regular exercise have been learned and established, it is important to continue eating right and exercising if you hope to continue losing weight and keep lost weight from returning.
Weight loss drugs are not for everybody. For example, there are limited studies on these medications' effects on older adults and on children.
Discussing Prescription Weight Loss Drugs With Your Doctor
Before a doctor will prescribe a prescription weight loss drug, he or she will ask you about the following: any existing allergies you may have, whether or not you are pregnant or breastfeeding, and what types of other drugs you may be taking. Existing medical conditions may also affect the use of these drugs. You should tell your doctor if you have any of the following conditions:
Diabetes
High blood pressure
Heart disease
Epilepsy (seizures)
Kidney disease
Glaucoma
Alcohol or drug abuse (or a history of)
Overactive thyroid (hyperthyroidism)
Depression or other mental illness
Migraine headaches requiring medication
Planning to have surgery requiring general anesthesia
Pregnancy or planning to become pregnant
Breastfeeding
People who are prescribed appetite suppressants should follow the prescription carefully. Because appetite suppressants may cause drowsiness or lightheadedness, it is important to know how you respond to these medications before you attempt to drive or operate machinery.
Xenical or Meridia Precautions
Follow the directions for taking Xenical or Meridia on your prescription label carefully. If there is any part that you do not understand, ask your doctor or pharmacist.
Do not take any more or less medicine than prescribed and do not take it more often than prescribed.
If you miss a dose, take it as soon as possible. However, if it is close to when you are scheduled to take your next dose, simply skip the missed dose and proceed with your regular schedule. Do not take a double dose.
These medications should be kept in their original container, tightly sealed and away from children.
They should be stored at room temperature, away from excess heat and moisture (not in the bathroom or near the kitchen sink).
Any medication that is outdated or unused should be thrown away.
Taking these weight loss drugs too often or in too large a quantity, or for longer than prescribed, can lead to addiction or, in worst-case situations, an overdose. Symptoms of an overdose can include confusion, convulsions, hallucinations, and coma. If you experience any of the following symptoms, call your doctor immediately.
A decrease in the ability to exercise
Chest pain
Swelling in the feet or lower legs
Difficulty breathing
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