Are the latest prescription diet drugs the answer to the nation’s obesity epidemic? For millions of Americans in search of a cure, optimistic advertising and recent research may seem to point to weight loss medications as a solution.
Research shows that all five drugs approved by the U.S. Food and Drug Administration (FDA) are effective, although some are more effective than others and all have side effects. However, doctors warn that if you are looking for a long-term weight loss solution, you won’t find it on drug store shelves. Drugs are a complement to a physician-prescribed weight loss plan — rather than the plan itself.
Yet, patients are hopeful, regularly showing up in doctors’ offices to ask for prescriptions.
“There are patients who come in, first-time visit, saying ‘I want to be on medications to lose weight. The majority of the time, they want the drugs right away,’” said Patricia Feito-Fernandez, M.D. [1], primary care physician with Baptist Health Primary Care. [2]
“What people need to understand is that it’s not as easy as it sounds. Medications will not cure the problem,” Dr. Feito said. “It’s more about habits and lifestyle. That’s the number one thing that patients really need to tackle before even considering medications for weight loss. Medicines are not a quick fix.”
Ruling Out Potential Causes
Your primary care physician is not likely to give you a prescription for diet drugs immediately. Unhealthy body weight often comes with serious health conditions that must be factored into any weight loss plan. Prescription diet drugs can cause significant side effects for some people depending on their health condition.
“It’s not something we go to right away,” Dr. Feito-Fernandez said. “It depends on what their risks are and their general health.”
Seeing your primary care physician is a good first step, however, because in addition to assessing your overall health, the doctor has to rule out potential causes of extreme weight gain before prescribing medication, including metabolism problems or other abnormalities.
“The majority of patients don’t realize there could be secondary factors causing their weight issues.”
‘I Put Them on Diets First’
In addition to lab tests, Dr. Feito-Fernandez said, she interviews patients thoroughly to piece together their medical and behavioral history. Then, she does what most patients probably least expect.
“I put them on diets first,” she said, “and have them see our nutritionist in conjunction with our obesity team. I prescribe a three-month weight loss plan, where I’m seeing them often enough to weight them and measure them. I need to see how they’re doing with their diet and lifestyle changes before even considering medications for weight loss.”
Continuing poor eating habits while using diet drugs can result in serious side effects.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about one-third of American adults are obese. Weight loss drugs may be prescribed for people with a body mass index (BMI) of 30 or higher. If you have at least one risk factor linked to obesity, such as Type II diabetes or high blood pressure and a BMI of 27 or above, your doctor may also prescribe medication.
Research has shown that losing just 5 percent of your initial weight lowers risk of Type II diabetes and heart disease, making the use of diet drugs a potentially significant supplement for some patients.
The Top Five
Results of a study published in June in the Journal of the American Medical Association (JAMA) showed that all five drugs are effective: Qsymia, Saxenda also known as Victoza, Belviq, Contrave and Xenical, also sold as Alli.
Researchers found that patients taking Qsymia lost the most weight, an average of 19 pounds in a year. Patients who took Xenical lost the least, 5.7 pounds in one year. However, researchers emphasized that results depend on choosing the medication that is compatible with the patient’s medical condition. The list of potential side effects and precautions are long for all diet drugs.
For obese patients who are diabetic, Dr. Feito has often prescribed Saxenda, also known as Victoza another drug that did well in the study. Patients lost an average of 12 pounds per year. Originally developed to treat Type II diabetes, it works by helping to control digestion, insulin and blood sugar. However, if patients fail to change their diets, the result could be serious side effects.
“A majority of patients lose weight, but it’s a matter of keeping the weight off with the changes that you’re making,” Dr. Feito-Fernandez said.
Because many patients are desperate for results, they don’t consider the long-term implications.
“You can’t be on medication forever,” Dr. Feito-Fernandez said.