Do you need help to manage the risk of obesity?
The Food and Drug Administration has approved four new anti-obesity drugs since 2012, presenting an option for the third of American adults who are obese. All of them suppress appetite and, as part of a program of healthy foods and exercise, typically shave off five to 10 percent of your body weight. "Having four more options is a wonderful start," says Martin Binks, secretary/treasurer of The Obesity Society and an associate professor of nutritional sciences at Texas Tech University in Lubbock.
Dropping 10 percent of your weight may not make you skinny but can dramatically cut your risk of type 2 diabetes, which is triggered by fat around the liver.
Many people think obesity is simply a matter of self-indulgence, remedied by ordinary eating habits and exercise. In fact, short-term lifestyle changes generally don’t produce dramatic or lasting weight loss, studies show. Bariatric surgery is much more effective, but has the disadvantages of any surgery. That’s why weight loss drugs, if they are safe and effective, could prove a godsend. The big problem will be paying for your medication and watching for side effects.
Why not just live with your ample proportions? In 2013, the American Medical Association officially recognized obesity as a disease. It increases your risk of not only type 2 diabetes but also heart disease, stroke, certain cancers, and osteoarthritis. Any weight loss lowers your risk.
The new drugs — Belviq, Qsymia, Contrave, and Saxenda, which must be injected — all interfere with hunger signals from the brain, explains Eric Ravussin, PhD, a physiologist at the Pennington Biomedical Research Center in Baton Rouge, La. Qsymia combines phentermine, a stimulant, and the anti-seizure medication topiramate, which is thought to suppress cravings. Contrave combines naltrexone, a drug to treat addiction to opioids or alcohol, and bupropion, known as Wellbutrin for people with depression and Zyban for smokers trying to quit. Saxenda is a higher dose of the diabetes drug Victoza. Your doctor may recommend one of them to you if you have a body mass index (BMI) of 30 or higher and have been unable to lose weight or keep it off, after making an effort with the help of nutritionists and exercise coaches. People with BMIs in the high 20s — considered overweight but not obese — who also have heart disease or diabetes may consider them as well. So far doctors don’t have good ways to match any of the four drugs to a patient.
The common side-effects — dry mouth, constipation and headache — can be unpleasant. Be sure also to talk to your doctor about the rare but serious side effects: Contrave can prompt suicidal thoughts, seizures, and elevated blood pressure; Saxenda can cause pancreatitis.
Before recently, the main option was Orlistat (sold over the counter as Alli and by prescription as Xenical). It works differently, by preventing some of the fat in food from being absorbed by the digestive system. Metformin, a common diabetes medication sometimes prescribed off-label for weight loss, lowers blood sugar levels. Both can be used indefinitely, although in 2012, the U.S Preventive Services Task Force, a non-partisan group of medical experts, ruled that there was not enough evidence about the long-term safety of either orlistat or metformin for weight loss. The stimulant phentermine may be prescribed for only up to three months. Many other weight-loss drugs posed too great a risk to the heart. Rimonabant, developed in the mid-1990s, suppresses appetite and weight gain in experimental animals and, in four major clinical trials, led people to lose about 10 pounds beyond the placebo effect, but two years after it was licensed in Europe, it was banned because of reports of psychiatric side effects.
The drugs don’t permanently change your appetite, and people tend to regain if they go off them, so if it works for you, you might want to stay on it longer — if you can afford it. The Medicare prescription drug program does not cover weight-loss drugs, and two-thirds of companies either don’t cover them at all or limit their use, according to Steve Miller, MD, the chief medical officer at Express Scripts, which manages drug benefits for many employers. The cost of any of the new pills runs $150 to $200 a month, minus any discounts you can find. At full price, Saxenda runs more than $1,000. So cost may rule out these medications for most people.
April 09, 2020
Christopher Nystuen, MD, MBA