February 1, 2023

In this video, Dr. Christopher McGowan explains the current array of FDA-approved weight loss medications, including phentermine, Qsymia (phentermine/topiramate), Saxenda (liraglutide), Contrave (naltrexone/buproprion). This discussion includes an overview of efficacy, side effects, and common myths and misconceptions.

Hi i’m dr mcgowan with trueyou weight loss i’m a bariatric endoscopist and obesity medicine specialist and i’d like to talk with you today about currently available medications to assist with weight loss so whether you’re using a medication in a medically supervised weight loss program or following a procedure or surgery the current medications can be very

Helpful in controlling appetite and helping to facilitate weight loss but there are many misconceptions about current medications many patients view these as diet pills but actually we’ve come quite a long way in the safety profile and effectiveness of medications many of the current misconceptions include that they’re dangerous that they don’t work that

There’s tons of side effects and that they are only short term but let’s dispel some of those myths and misconceptions and discuss the specific options that are currently available so the medications that i discussed today are fda approved for the following indications obesity which is a body mass index of 30 or higher overweight with a body mass index of 27

Or higher with co-existing medical problems such as high blood pressure high cholesterol or diabetes currently available medications include orlostat phentermine phentermine plus topiramate also known as kusemia loragliotide also known as saxenda and naltrexone plus bupropion also known as contrave please note that beta hcg or hcg is not fda approved and is

Not a weight loss medication but more to come on that later now all of these medications are prescription only with the exception of oral stat which is available over the counter and note that none of these should be used during pregnancy so let’s start with orlistat this medication is available over the counter or at higher doses is available by prescription

And oral stat works by blocking digestion of fat specifically it blocks an enzyme called pancreatic lipase which is key in digesting fats this leads to an increased passage of fat through the small intestine and out the body and as a result you do not digest approximately one third of the fat that you eat and you’ll lose weight the expected weight loss with

Orlastat is approximately five percent of body weight so if you weigh 200 pounds you could expect to lose approximately 10 pounds however because it blocks the absorption of fat oil stat can lead to some very bothersome side effects these include gas bloating loose stools and even oily discharge and nobody likes oily discharge so in general this is not one

That we frequently recommend but it is an option and it’s very safe the key to mitigating these side effects is to eat less than 30 fat in your diet and then you’ll have less of the bothersome side effects and in time most of these will improve the other risk of taking this medication is it could affect your absorption of certain vitamins including a d e and k

What we call the fat soluble vitamins so it’s important to supplement with a multivitamin okay moving on to phentermine now phentermine has been available forever it was actually approved in 1959 and has been available since then phentermine is not fenfen so phentermine is a component of fenfen which was available previously but removed from the market because

The other component the other fen phenfloramine caused heart valve problems but phentermine itself is safe and still fda approved and still a great medication in certain instances though phentermine is classified as a stimulant it really works through a different mechanism primarily it increases your sense of fullness or satiety and causes some suppression of

Appetite phentermine is only fda approved for 12 weeks though can be used safely for longer than that and typically we would use these medications for a minimum of 12 weeks to assess response and if it’s effective we can continue using them longer term as with oral stat the expected weight loss with phentermine is approximately five percent of body weight and

The main side effects of phentermine would be elevated blood pressure anxiety sometimes insomnia or feeling jittery a lot of these will resolve with time though they can be bothersome to some patients next is combination phentermine and topiramate also known as brand name kusemia this is a newer combination medication which shows better weight loss outcomes

Than just phentermine so phentermine we’ve talked about topiramate is the other component topiramate was developed as a seizure medication or a migraine medication and it was found early on that one of the main side effects when patients were taking this was weight loss so it was later investigated and it is now known that topiramate works through receptors

In the brain specifically the hypothalamus to induce weight loss primarily by curbing appetite and in combination with phentermine we can see double the weight loss that we see with phentermine alone so potentially 10 of your body weight specific side effects of topiramate include tingling in the fingers mouth and toes this is usually mild and not dangerous it

Can also cause kidney stones and potentially glaucoma and it can cause a birth defect so you cannot get pregnant when taking this medication but overall it’s very well tolerated so looking at independent studies kusemia or this combination is currently perhaps the most effective weight loss medication but it depends on an individual person’s response the next

Medication to discuss is naltrexone plus bupropion bupropion is also known as wellbutrin which is an antidepressant and anti-anxiety medication naltrexone is an opiate receptor blocked and is used in opiate addiction and may or may not produce further weight loss when used in combination with bupropion but the combination is fda approved under the name contrave

Average weight loss with this medication is approximately five percent and side effects would include nausea constipation diarrhea and antidepressants can cause sexual dysfunction and keep in mind that this medication cannot be used if you have a history of seizures personally i find this medication to be less effective than some of the other options and so

It’s not typically a first line medication in my program it can be useful for someone who’s also trying to stop smoking because bupropion is also helpful in that circumstance okay moving on to laraglotide also known as saxenda laraglotide is an injectable medication patients inject once a day using a pen-like device with a small needle and inject the medicine

Under the skin glycotide is a medication that boosts a naturally occurring hormone in the body called glp-1 or glucagon-like peptide 1. this hormone is a very powerful one and helps to promote weight loss and also helps to control blood glucose so this medication can also be used for diabetes but for weight loss the medication works through the brain to control

Hunger it also works through the stomach and slows stomach emptying so you feel full for a longer period of time so boosting these levels of glp1 will promote weight loss and the average weight loss is approximately five to ten percent of body weight so also fairly significant in my program we like lyraglate in combination with some of the procedures that we

Perform for instance the endoscopic sleeve gastroplasty or the orbera balloon these are procedures which slow stomach emptying by their very nature so when we combine that with laraglite we get a further slowing of stomach emptying which can boost weight loss and there are some early studies showing that weight loss can be increased by approximately five percent

With the addition of these medications so if you take a procedure like esg the endoscopic sleeve with an average of 20 percent weight loss we can then boost that to 25 average which is then quite significant and nearly equivalent to a surgical procedure common side effects of saxenda include nausea which is why the medication is increased week by week until the

Maximum dose is reached it can also cause constipation diarrhea and decreased appetite clearly because that’s how it’s working very rarely it has been linked to pancreatitis and a rare form of thyroid cancer in animals but overall the safety profile is excellent and it has very few interactions with other medications or in patients with other health problems

The biggest problem with saxenda though is cost if it is not covered by insurance here in the united states it is really expensive typically more than a thousand dollars a month and really not a good option in that scenario okay so what about hcg you may have seen weight loss clinics advertising hcg for weight loss hcg stands for human chorionic gonadotropin

And there are clinics that promote this as a weight loss medication it’s injected into the body and typically combined with a very low calorie diet less than 500 calories per day please note hcg is not a weight loss medication it is not approved by the fda and multiple studies have shown it doesn’t cause weight loss so it should never be used unfortunately it

Is still out there so in fact the american medical association has stated decades ago that hcg is not appropriate for weight loss the fda mandates that all preparations of this need to include a warning label saying that it cannot be used for weight loss but it is still out there used off label so do not use hcg for weight loss and keep in mind it’s dangerous

To follow a very low calorie diet for a prolonged period of time and a low very low calorie diet is actually not more effective than a standard diet so in other words not an option not safe don’t use it so there you have it we currently have multiple very effective and actually very safe medications to help with weight loss so for our patients we look at these

Options and choose what we think would be the best based on their other medical problems maybe looking at the side effect profile and also considering cost and then it’s very important after starting these medications to closely monitor weight loss and ensure that the medicine is working for more information on current weight loss medications as well as endoscopic

Weight loss options you can find out more information at trueyouweightloss.com

Transcribed from video
Weight Loss Medications: An Overview By Christopher McGowan MD