By Caroline Cederquist, M.D.
In the past few years, several medications have been approved and are being used for the treatment of weight problems. Until recently, there were very few prescription medications available which were FDA approved for this purpose. Of the medications available prior to 2014, all were approved for short term use not long term or on-going use.
Until recently, the only FDA appetite suppressants were really a short term solution for a chronic medical condition. Over the previous decades, overweight and obesity were really considered to be “lifestyle” issues. Medications were approved to be used short term in conjunction with a diet and exercise program. Once the “lifestyle problem” was fixed, so should the weight problem be fixed and medication then stopped.
Ongoing research over the years, along with the substantial increase in weight problems in our country makes this short-term treatment no longer so useful. Right now, with 67-70% of adults overweight in the United States, you are in the majority if you are overweight. Overweight has been described as an epidemic and unfortunately, it is not only of cosmetic concern. Almost everyone is now aware that being overweight places you at significantly higher risk for heart disease, stroke, diabetes, many cancers, high blood pressure, arthritis, sleep apnea, esophageal reflux, infertility – essentially almost all of the long-term chronic health conditions that we suffer from in the U.S.
Overweight is now looked upon as a chronic condition which has to be managed long term. A shift in diet along with consistently getting exercise and movement is key to preventing and treating weight problems. However, now it is realized that when a person becomes overweight, metabolism dysfunction sets in and it becomes easier for more weight to be gained. Often, more help is needed than can be obtained with lifestyle changes alone.
Interestingly, as a physician who specializes in weight management, the majority of my patients are not on weight loss medications. There are several reasons for this. Frist, I have structured my medical practice to work extensively with patients one on one to develop a meal program that can work with metabolic issues present. Our three full time dietitians work to provide one on one individualized counseling which is so important to create a real-life meal plan that works for each patient.
Second, when blood sugar problems, thyroid problems and vitamin deficiencies are corrected, many patients who had previously found it impossible to lose weight, are finally able to lose weight. Lastly, many of my patients have significant medical conditions and medications for weight loss can aggravate those conditions.
However, medications are a tool that may prove useful for the right patient as part of a comprehensive plan. We have four newer medications available to us that have a role in weight management. They are all to be used in connection with diet and lifestyle changes. Studies required for FDA approval showed that they could produce a 5% loss of body weight over placebo. For a 200 pound person, this equates to a ten pound weight loss. It is important to realize that most people who are candidates for weight loss medication really need to lose much more than that. There is no magic bullet that allows weight loss without a decrease in caloric intake however, these medications may help by decreasing hunger and constant thoughts of food that can increase when dieting. All of the medications have specific benefits and of course risks and side effects. Use of a medication requires careful selection by a physician and then monitoring for safety and effectiveness.
Medications approved in the past few years.
Qsymia – contains a low dose of phentermine (an old appetite suppressant) and topirimate (a medication used for seizure prevention). This works in the brain to decrease appetite.
Belviq – This is a medication that also works in the brain to decrease hunger.
Contrave – This medication also contains two medicines. It contains the antidepressant buproprion and naltrexone which is used to treat opioid over dose and addition. This helps with hunger and thoughts of food.
Saxenda – This is an injectable medication that helps with hunger hormones and blood sugar regulation.
Cederquist Medical Wellness Center
1575 Pine Ridge Rd Suite 19
Naples, FL 34109