Weight-Loss Meds

If only the magic bullet for weight control really existed. We could pop a pill every day that would allow us to eat what we wanted, when we wanted. This pill would banish diabetes, high blood pressure[1], and high cholesterol[2]. We’d be a lot happier, too. Unfortunately, all of this is wishful thinking. A magic bullet, whether it be pill, potion, or powder, has yet to surface.


A lot of options exist for helping with weight loss, but there are pros and cons to all of them. Diets are hard to follow, exercise takes time, behavior modification is hard, and surgery seems drastic. Medications are a possibility, but it’s important to realize that they have side effects, they still require that you alter your eating and exercise habits, and the amount of weight that you can expect to lose is fairly moderate. Nevertheless, medication is an option for many people who need a little bit of extra help to lose weight. Let’s take a look at a few of them.

Orlistat (brand names Xenical and alli)
Orlistat is available in prescription form as Xenical and in nonprescription, or over-the-counter, form as alli. This drug is known as a lipase inhibitor and it blocks some of the fat — about 30% in the case of Xenical and 25% in the case of alli — that’s in the food you eat from being absorbed in the intestines. Unabsorbed fat is excreted in the stool. It can also block the absorption of fat-soluble vitamins and beta-carotene, so it’s advised to take a multivitamin when taking this drug.

The medicine is taken three times a day, during or after a meal that contains no more than 15 grams of fat. Studies indicate that the average weight loss when orlistat is taken for six months is about 12 to 13 pounds.

If you’re thinking about taking orlistat, be prepared for the rather unpleasant side effects: gas, oily spotting, an urgent need to have a bowel movement, loose stools, difficulty controlling bowel movements, an increase in the number of bowel movements, stomach and rectal pain, headache, anxiety, kidney stones, and liver failure. Of course, these side effects don’t occur in everyone who takes orlistat, but it’s important to be aware of them. Also, some of the GI side effects can be lessened by not eating meals that are too high in fat (which is probably a good idea anyway, if you’re trying to lose weight).

Lorcaserin (brand name Belviq)
Belviq was approved in June of 2012. This drug is known as a serotonin agonist and works by activating serotonin receptors in the brain, which supposedly helps to increase the feeling of fullness. It is approved for people with a body-mass index (BMI) of 30 or higher, and for people with a BMI of 27 and at least one other weight-related condition such as Type 2 diabetes or high blood pressure. Also, Belviq is only effective if you also follow a reduced-calorie eating plan and get regular exercise.

How effective is Belviq? If you take it as directed (twice daily, with doses adjusted until the desired effect is achieved), cut your calorie intake, and make sure you’re physically active, you can expect to lose about 5% of your body weight. In one study, people with an average body weight of 220 pounds lost, on average, 10 to 12.5 pounds after one year. Because this is a new drug, it’s considered safe to take for up to two years.

Belviq can be taken at any time of the day, with or without food. Side effects include headache, dizziness, fatigue, constipation, and difficulty sleeping. Low blood glucose may occur in people with diabetes. Depression and thoughts of suicide are also side effects, so anyone taking this drug must be monitored carefully for mood and behavioral changes.

Topiramate/phentermine (brand name Qsymia)
Another relatively new drug, Qsymia was approved by the FDA in July of 2012. Topiramate is an anti-seizure medication and phentermine is an appetite suppressant. Like Belviq, this drug is approved for those with a BMI of 30 or higher, or with a BMI of 27 or higher with another weight-related condition. As with Belviq, Qsymia works best when used along with a weight-reduction eating plan and plenty of exercise.

As far as effectiveness, Qsymia leads to about the same amount of weight loss as Belviq — about 5% of body weight, although one trial showed an average weight loss of between 7% and 9%. Side effects include low blood glucose in people with diabetes, dizziness, tingling in the hands and feet, insomnia, constipation, and altered taste. People who have hyperthyroidism or glaucoma should not take this drug. It can also cause birth defects, so women of childbearing age who wish to take it must take monthly pregnancy tests and use contraception. Qsymia is taken once a day, usually in the morning. The dose may be adjusted up if at least 3% of initial weight isn’t lost after 12 weeks. Thus far, the highest dose of this medicine can be given safely for up to 56 weeks.

Cost considerations
If you’re thinking that weight-loss medication is the way to go, of course, first have a discussion with your health-care provider. If you get the green light, you then need to think about the cost. Not all health plans will cover the cost of weight-loss medicines. The average cost of Qsymia is around $160 to $240 per month (depending on the dose); Belviq is about $200 per month, and Xenical is about $160 for 90 pills (a 30-day supply). Carefully weigh the cost against a relatively small amount of weight loss that you can expect. Then, decide if it might be more cost-effective to join a weight-loss program or pay for sessions with a personal trainer, for example.

There are no right or wrong answers here, so you need to decide what’s best (and safest) for you. Remember, too, that medications are not a cure for overweight or obesity, and if you stop taking them, there’s a good chance that you’ll gain the weight back. So, no magic bullet yet!

  1. high blood pressure: http://www.diabetesselfmanagement.com/articles/heart-health/the-pressure-is-on
  2. high cholesterol: http://www.diabetesselfmanagement.com/articles/heart-health/lifestyle-habits-for-lipid-management

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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