Pharmacologic Therapy Options for Overcoming Obesity

For decades, obesity has increased in prevalence, becoming one of the major health issues in modern American society. Unlike many ailments, the causes of obesity are well-researched and can often be attributed primarily to lifestyle factors such as diet and exercise. This increase in the proportion of obese Americans is directly correlated to the steady rise in caloric intake and decrease in physical activity levels among the population.

With the understanding of obesity being so prevalent, one would think the solution to be straightforward – simply eat less and exercise more. In reality, this intuitive response to the problem isn’t necessarily effective, as many patients are unable to achieve their desired results, despite making major lifestyle changes. Some of these individuals can benefit from prescription medications that can increase their efforts and help them reach a healthy weight.

Prescription Weight-Loss Medications: An Overview

Who are they intended for?

Even though many Americans prefer taking a pill or injection to reduce a few pounds, weight loss medications are not suitable for use by moderately overweight individuals. These products are used primarily to treat patients with more severe obesity who face debilitating secondary conditions due to their weight.

When determining whether a candidate for weight loss medications is suitable, physicians commonly start by evaluating their patient’s BMI. BMI, or Body Mass Index, merely indicates the association between a patient’s height and weight. Watching proportions concerning height is helpful because the height of healthy weight for each individual can vary substantially due to the size of their body frame.

However, various factors besides height affect how heavy an individual can safely be, such as their lean body mass, age, exercise level, and medical history. Thus, though doctors refer to BMI as the starting point for their evaluation, they will likely want to review other factors as well.

The body mass index (BMI) is a useful indicator of whether weight loss is possible for a patient. A BMI of 30 (or 27, if the patient has weight-related conditions) or higher may indicate that they’re a candidate for such drugs. Physicians often ask whether lifestyle modifications have been made and may recommend such measures if they haven’t already been considered.

Who are they not intended for?

While the prescription weight loss drugs said to be generally safe and effective have also been reported to be unsuitable for certain groups of people in certain circumstances, such as pregnant or breastfeeding women, the medications have been deemed safe for use in others. Individuals with a history of disordered eating or body dysmorphia might also be advised to avoid such medications in light of the possibility of additional episodes.

If a patient takes one of these medications for a time with no indication of success, a physician may recommend that they stop taking it, and may also recommend trying an alternative. To this end, doctors must be monitoring and evaluate the patients for side effects or complications, and may decide that the risks of adverse health effects caused by continued treatment outweigh any possible health benefits the patient is experiencing.

Always consult a medical professional before making changes to your medical treatment, including switching any medication on or off.

Expected outcomes

The success of virtually any diet regime will depend on many variables, and with so many diverse medications available, it is not possible to give a comprehensive evaluation of their effectiveness. Various medications may have different average success rates, and can also have different efficacy between people. The performance of drugs will depend on each patient’s particular lifestyle situation, medical history, genetics, and other factors.

There are, however, some general statements about the probable effectiveness of weight loss medication programs that cannot be disputed. Research comparing the success rate of these groups utilizing prescription medications alongside behavioral changes versus those using behavioral changes alone has demonstrated that the medicated groups were able to achieve approx. 12% more weight loss than their counterparts. As has been noted, one should be careful about overgeneralizing these figures to all medications and patients.

However, the effectiveness of weight loss drugs has generally been proven in scientific literature.

Side effects and concerns

In general, prescription medications are only approved for use in patients after they have been identified as safe and effective to a reasonable degree. However, these medications are not completely risk-free, and patients should thoroughly discuss the pros and cons of any medication with their doctor before deciding whether to receive it. Many doctors strongly recommend that patients avoid taking weight loss medications exclusively for cosmetic reasons. These drugs are intended as a safeguard against health risks stemming from an unhealthy body composition.

It is typical to experience some unpleasant side effects when beginning any new medication. The side effects one may experience with any weight reduction medication may vary, but usually, these medications can cause gastrointestinal distress of various types. Nausea, vomiting, and diarrhea are some examples that are common among non-uncommon side effects of proudly served meals. The frequency of these side effects generally fluctuates over time.

Please allow us to point out that more serious complications can arise with several weight-loss medications. While these are far less common than the more common side effects, patients should be made aware of these risks before commencing a new treatment. Be sure to consult your doctor about the risk of experiencing side effects from a new medicine before beginning, and read the literature included with your prescription before starting a course of the medication.

In addition to that, cost and coverage should also be considered. Though a weight-loss drug may be deemed medically necessary by your doctor, your insurance plan may choose otherwise. Unfortunately, many of these medications, particularly the latest additions to the list, are expensive enough to make them impractical for the vast majority of people without insurance. Furthermore, while many off-label weight-loss medications may be beneficial, being non-FDA-approved precludes their inclusion in most insurance plans.

Popular Examples

At the time of this article’s writing, the FDA has approved six medications for treating chronic weight problems for long-term use. However, prescription drugs are commonly prescribed off-label for conditions for which they have not yet been specifically authorized. Thus, several medications are given off-label for weight loss despite being not specifically authorized for this purpose.

This section will provide a brief overview of some of the most popular medications prescribed on- and off-label for the treatment of chronic obesity in adults.

The GLP-1 modulators

Weight loss regimens are currently the subject of numerous medications belonging to this classification. Big names like Ozempic and Wegovy have achieved mainstream status because of their connections with household celebrities and their supposedly dramatic results. Nevertheless, they constitute only a small portion of a larger group of similar medications.

GLP-1 receptor modulators affected the metabolism in ways that made them useful in diabetes treatment. Their effects were achieved by interfering with the normal function of the GLP-1 system, which influences appetite, digestion, and insulin sensitivity. These side effects were found to be able to help weight loss, but not all the drugs in this category have been officially recognized for this purpose. As a result, some of these medications may only be prescribed off-label for this purpose. These factors may distinguish these two medications, and it is important to take a closer look.

At the time of this publication’s publication, only two GLP-1 receptor agonists were FDA approved for weight loss: Wegovy (semaglutide) and Saxenda (liraglutide). These two drugs are quite similar, with some important differences.

Saxenda is a lot like Wegovy’s older sibling. Long before semaglutide had ever been approved for type 2 diabetes, the FDA had already acknowledged Saxenda as a possible treatment for obesity. Liraglutide’s background started as type 2 diabetes treatment (under the brand name Victoza). It was not surprising at the time, as other anti-diabetic GLP-1 receptor agonists had already existed. However, Saxenda became the first-ever in its class to receive FDA approval for weight loss.

Since then, wegovy has been included in FDA-approved rank lists. However, whereas Saxenda required daily injections, wegovy’s once-weekly dosage schedule provides a considerable advantage in terms of convenience. Mounjaro has also been reported to be more effective, with some studies reporting a 10% recovery rate in patients treated with Wegovy compared to those treated with Saxenda. Side effects between the two treatments are similar, but patients may have very different experiences with each medicine.

In the US, doctors are permitted to prescribe medications for purposes for which they are not specifically indicated. As such, many weight loss medications in this setting are frequently prescribed even though they are not approved for that purpose.

Perhaps the most significant entry in this section is Ozempic. This semaglutide dosage is only approved for type 2 diabetes, despite containing the same active ingredient as Wegovy. However, this drug has made waves as a potential weight-loss aid thanks to its promotion by high-profile influencers online.

Closely related to Ozempic is Trulicity, another GLP-1 receptor agonist known generically as dulaglutide. Its similarity to this product is low, so there is little to say about a comparison between Ozempic and Trulicity. Like the rest, Trulicity may be prescribed off-label for chronic weight issues or for its intended use in treating type 2 diabetes in adults. The effectiveness and side effects of Trulicity and Ozempic are similar. However, these drugs may not be interchangeable, and patients should not assume they can switch from one to another without discussing it with their doctor.

Finally, let’s consider Mounjaro (tirzepatide), an unusual member of the GLP-1 family. While it has a modest capacity to bind to GLP-1 receptors, this is no longer its main mode of action. This drug can also interact with a different site known as GIP which contributes to metabolism and intracellular membrane permeability.

The enhanced effect of acting on both sites is synergistic, resulting in superior outcomes than would be produced with a single action. However, patients should know that Mounjaro is only approved for type 2 diabetes and may not be superior to other GLP-1 agonist therapy for weight loss.

Orlistat

While drugs like Ozempic and Wegovy have gained much popularity in the dieting aid field in recent years, they are not the only class of contenders. The GLP-1 receptor system is just one of many factors involved in the regulation of metabolism that could be manipulated.

One example of such a supplement is Orlistat. This FDA-approved weight-loss aid reduces the production of enzymes that break down dietary fats, thereby decreasing fats’ absorption during the digestive process. The medication may have other effects on carbohydrate metabolism that aid with fat loss.

However, Orlistat is a comparatively old medication. It was approved in 1999, about two decades before many GLP-receptor agonists were released. Its age is reflected in comparisons with newer medications when it comes to efficacy and side effects. For example, a study by Orlistat showed that it resulted in weight loss of 8.5 lbs per year, whereas weight loss was 18 lbs in the Saxenda group.

Conclusion

Keeping to wholesome body weight can be challenging today. Many people struggle to watch what they eat and attempt to force themselves on the exercise equipment, only to find that the numbers on the scale barely budge. These people may experience an inconvenience, while others, whose weight is so high it could affect their health, may have genuine cause for concern if they cannot bring their weight within a healthy range.

Some of these patients might wish to discuss their eligibility for prescription weight loss medication with their doctor. A physician may believe that one of the many options may be medically helpful and prudent for their weight loss program.

References

Santos, dos, Pereira, Uilson et al. (2018, June 28). Physicochemical Characterization, Microbiological Quality and Safety, and Pharmacological Potential of Hancornia speciosa Gomes. Oxidative Medicine and Cellular Longevity, 2018, 1-17. https://doi.org/10.1155/2018/2976985