Adding a Weight-Loss Medicine to Your Healthy Lifestyle Plan

Losing and maintaining weight are challenging. Although lifestyle changes always are a necessary part of the process, many people wonder if and when they should consider a doctor-prescribed weight-loss medicine for additional assistance.

Currently, five weight-loss medicines (or combinations) are approved by the U.S. Food and Drug Administration (FDA) for long-term use. These medicines are approved for individuals whose body-mass index (BMI) is greater than 27 kg/m2 and who have one or more obesity-related complications, including high blood pressure, Type 2 diabetes, or abnormal cholesterol. They also are approved for those whose BMI is greater than 30 kg/m2 without complications who are motivated to lose weight.

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The decision to add a weight-loss prescription medicine to your lifestyle change plan is made with your health-care provider, who will address the pros and cons of each drug and assess whether it is appropriate based on your health history and current prescription medicines, including those for blood glucose management. Expected weight loss from these medicines varies slightly but on average, according to information published by the drug manufacturers, individuals can expect a 5% to 10% loss in body weight.

According to FDA guidelines, all weight-loss medicines are classified as category X and are contraindicated for women who are pregnant or may become pregnant.

Medication: Generic drug name/brand names
Orlistat
Alli®, GlaxoSmithKline
Xenical®, Roche Laboratories

How it works
Orlistat is a lipase inhibitor. It works to prevent about 30% of the fat you eat from being absorbed into the intestines. The unabsorbed fat is eliminated in the stool.

Common side effects
Oily stools, loose stools, need for urgent bowel movements, pain or discomfort in the rectum, stomach pain, headache, and anxiety

Medication: Generic drug name/brand name
Lorcaserin
Belviq®, Arena Pharmaceuticals

How it works
Lorcaserin is a serotonin receptor agonist. It targets a hunger receptor in the brain that aids in satiety, or the feeling of fullness. It helps individuals feel full while eating less food.

Common side effects for people with diabetes
Hypoglycemia (low blood sugar), back pain, cough, headaches, and fatigue

Medication: Generic drug name/brand name
Phenteramine/Topiramate ER
Qsymia®, Vivus

How it works
A combination medication that works in two different ways to help reduce hunger and improve satiety, although the specific mechanism of action is still unknown.

Common side effects
Paraesthesia (tingling or pricking sensation), dizziness, dysgeusia (distorted sense of taste), insomnia, constipation, and dry mouth

Medication: Generic drug name/brand name
Naltrexone/Bupropion
Contrave®, Takeda Pharmaceuticals

How it works
A combination medication that helps decrease appetite and works to curb hunger and food cravings. The exact mechanism of action is still unknown.

Common side effects
Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea

Medication: Generic drug name/brand name
Liraglutide
Saxenda®, Novo Nordisk

How it works
Liraglutide is an incretin mimetic that slows the emptying of the stomach, aiding in satiety and decreasing appetite.

Common side effects
Nausea, diarrhea, constipation, hypoglycemia, vomiting, headache, decreased appetite, upset stomach, tiredness, dizziness, stomach pain, and changes in enzyme (lipase) levels in the blood