ObsiQ
Your go-to for reliable information on obesity medications, backed by physicians.
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Developed with the consultation of a Board-Certified Endocrinologist to help patients navigate a complex topic and have access to reliable data sources for further information. Please consult your physician for your own specific needs.
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What is Obesity?
Obesity is when a person holds on to more weight than their body can support properly, to the point that it
can be dangerous to one’s health.
BMI (Body Mass Index)
This calculation is used to decide whether a person is underweight, at a healthy weight, overweight, or has obesity. It is calculated based on a person’s height and weight.
A BMI between 25 and 29.9 is considered overweight.
A BMI of 30 or greater is considered to be in the obesity range
This may vary depending on your ethnic background.
Obesity is considered to be a chronic disease because it increases the risks of many different health problems.
Health Risks
Having obesity increases a person's risk of developing many health problems. It can also make it hard to do daily tasks such as breathing.
Here are a few examples:
- Diabetes
- High blood pressure
- High cholesterol
- Heart disease (including heart attacks)
- Stroke
- Sleep Apnea (a disorder in which breathing stops for short periods while asleep)
- Asthma
- Cancer
- Metabolic Syndrome
- Polycystic ovarian syndrome
Obesity has become a major international public health problem. The prevalence of obesity has continued to increase significantly over the years in the United States and throughout the world.
Many people want to lose weight in order to improve their health and lower their risk of other chronic health problems like heart disease and diabetes, but it can be hard to get started on a program that can be maintained overtime.
Medications
Who is qualified for obesity medication?
It depends on the BMI and presence of other chronic health conditions that can be directly linked to obesity. Weight loss medicines are typically recommended for people who have not been able to lose weight with lifestyle changes (diet and exercise) alone and have a:
- Body mass index (BMI) of 30 or more
- BMI between 27 and 29.9 and have other medical problems (i.e. diabetes, high cholesterol, or high blood pressure)
Medication may be helpful for weight loss when used in combination with diet, exercise, and lifestyle changes.
However, it is important to understand the risks, benefits, and limitations of these medicines (i.e. side effects, expense, insurance coverage, long term use, etc.).
Not everyone will achieve their target weight but it is important to keep in mind that even a small reduction in weight can contribute to reducing risk of major chronic conditions such as diabetes or heart disease.
There is no one particular medication that works the best for everyone.
The best weight loss medicine for you is determined based on your situation, personal preferences, and medical history.
Make sure to contact your physician with any questions or concerns.
Alli (Orlistat)
Generic name: Orlistat
Pancreatic lipase inhibitor approved for long term use
Dosing:
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Abdominal cramps, flatulence, fecal incontinence, oily spotting, reduced absorption of fat-soluble vitamins. Rarely reported: severe liver injury, kidney injury.
Contrainidicated during pregnancy
Qsymia (Phentermine-topiramate)
Generic name: Phentermine-topiramate
Combination of phentermine-topiramate approved for long-term use
Usual dosing (adults):
Contact your physician for dosing information
Controlled substance
Adverse effects and precautions:
Dry mouth, change in taste, constipation, numbness, depression, anxiety, elevated heart rate, cognitive disturbances, insomnia (higher dose).
Abuse potential due to phentermine component.
Topiramate can cause birth defects (increased risk of oral cleft defects).
Medication must be tapered off and cannot be suddenly discontinued.
Contraindicated during pregnancy, hyperthyroidism, glaucoma, patients taking MAO inhibitors.
Contrave (Bupropion-Naltrexone)
Generic name: Bupropion-naltrexone
Combination of bupropion-naltrexone approved for long-term use
Usual dosing (adults):
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Nausea, headache, constipation, vomiting, dizziness, insomnia, dry mouth can occur.
Temporary increases in blood pressure and heart rate during the first 12 weeks of treatment can occur.
Contraindicated in patients with uncontrolled hypertension, seizure disorder, eating disorder, use of other bupropion-containing products, chronic opioid use, use within 14 days of MAO inhibitors, pregnancy, or breastfeeding.
Adipex (Phentermine)
Generic name: Phentermine
Other brand names: Lomaira, Suprenza
Noradrenergic sympathomimetic drug approved for short-term use
Usual dosing (adults):
Contact your physician for dosing information
Controlled substance
Adverse effects and precautions:
Recommended for short-term use (12 weeks or less at a time).
Side effects include increase in heart rate, blood pressure (may counteract effect of blood pressure medications), insomnia, dry mouth, constipation, nervousness.
Medication has a potential for abuse.
Avoid in patients with heart disease, poorly controlled hypertension, pulmonary hypertension, or history of addiction or drug abuse.
Contraindicated in patients with a history of CVD, hyperthyroidism, glaucoma, MAO inhibitor-therapy, pregnancy, or breast feeding.
Regimex (Benzphetamine)
Generic name: Benzphetamine
Noradrenergic sympathomimetic drug approved for short-term use
Usual dosing (adults):
Contact your physician for dosing information
Controlled substance
Adverse effects and precautions:
Recommended for short-term use (12 weeks or less at a time).
Side effects include increase in heart rate, blood pressure (may counteract effect of blood pressure medications), insomnia, dry mouth, constipation, nervousness.
Medication has a potential for abuse.
Avoid in patients with heart disease, poorly controlled hypertension, pulmonary hypertension, or history of addiction or drug abuse.
Contraindicated in patients with a history of CVD, hyperthyroidism, glaucoma, MAO inhibitor-therapy, pregnancy, or breast feeding.
Tenuate (Diethylpropion)
Generic name: Diethylpropion
Noradrenergic sympathomimetic drug approved for short-term use
Usual dosing (adults):
Contact your physician for dosing information
Controlled substance
Adverse effects and precautions:
Recommended for short-term use (12 weeks or less at a time).
Side effects include increase in heart rate, blood pressure (may counteract effect of blood pressure medications), insomnia, dry mouth, constipation, nervousness.
Medication has a potential for abuse.
Avoid in patients with heart disease, poorly controlled hypertension, pulmonary hypertension, or history of addiction or drug abuse.
Contraindicated in patients with a history of CVD, hyperthyroidism, glaucoma, MAO inhibitor-therapy, pregnancy, or breast feeding.
Bontril (Phendimetrazine)
Generic name: Phendimetrazine
Noradrenergic sympathomimetic drug approved for short-term use
Usual dosing (adults):
Contact your physician for dosing information
Controlled substance
Adverse effects and precautions:
Recommended for short-term use (12 weeks or less at a time).
Side effects include increase in heart rate, blood pressure (may counteract effect of blood pressure medications), insomnia, dry mouth, constipation, nervousness.
Medication has a potential for abuse.
Avoid in patients with heart disease, poorly controlled hypertension, pulmonary hypertension, or history of addiction or drug abuse.
Contraindicated in patients with a history of CVD, hyperthyroidism, glaucoma, MAO inhibitor-therapy, pregnancy, or breast feeding.
Saxenda (Liraglutide)
Generic name: Liraglutide
GLP-1 agonists approved for long-term use.
Usual dosing (adults):
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Medication causes modest delay of gastric emptying resulting in varying degrees of GI side effects.
These include nausea, vomiting, diarrhea, constipation, and bloating. Others are hypoglycemia (if on other diabetes medications), injection site reactions, increased lipase, and increased heart rate. Rarely reported: pancreatitis, gallbladder disease, renal impairment, suicidal thoughts.
Possible increase in thyroid cancer risk based on rodent model data.
Contraindicated in pregnancy and in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.
Wegovy (Semaglutide)
Generic name: Semaglutide
GLP-1 agonists approved for long-term use.
Usual dosing (adults):
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Medication causes modest delay of gastric emptying resulting in varying degrees of GI side effects.
These include nausea, vomiting, diarrhea, constipation, and bloating. Others are hypoglycemia (if on other diabetes medications), injection site reactions, increased lipase, and increased heart rate. Rarely reported: pancreatitis, gallbladder disease, renal impairment, suicidal thoughts.
Possible increase in thyroid cancer risk based on rodent model data.
Contraindicated in pregnancy and in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.
**Monitor patients with diabetic retinopathy for eye complications.
Plenity (Oral super-absorbant hydrogel)
Generic name: Hydrogel
Cellulose and Citric Acid matrix that occupies space in the stomach and small intestine to create a feeling of fullness and satiety.
Usual dosing (adults):
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Diarrhea and bloating can be common. Frequent bowel movements, flatulence, and abdominal pain can also occur.
Use is cautioned in patients with active GI diseases.
Zepbound (Tirzepatide)
Generic name: Tirzepatide
GIP and GLP-1 agonists approved for long-term use.
Usual dosing (adults):
Contact your physician for dosing information
Not a controlled substance
Adverse effects and precautions:
Medication causes modest delay of gastric emptying resulting in varying degrees of GI side effects.
These include nausea, vomiting, diarrhea, constipation, and bloating. Others are hypoglycemia (if on other diabetes medications), injection site reactions, increased lipase, and increased heart rate. Rarely reported: pancreatitis, gallbladder disease, renal impairment, suicidal thoughts.
Possible increase in thyroid cancer risk based on rodent model data.
Contraindicated in pregnancy and in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.
**Monitor patients with diabetic retinopathy for eye complications.
Common Questions
Can obesity medications be used as a standalone treatment, or should they be combined with lifestyle changes?
Yes they can, but it is highly recommended that they go with lifestyle changes. Weight loss is more effective with both of these approaches combined, and this would decrease dependency on medications. Also, it would increase the likelihood of maintaining most of the weight off when medication use is discontinued.
Are there any age restrictions for using obesity medications?
Currently, obesity medications are only approved for ages 18 and above.
How long does it typically take to see results with obesity medications?
It varies person to person, and depends on if the medication is the right fit for the person as well as what other lifestyle changes are made with it. Some people lose weight more quickly and then plateau, some people lose more constantly throughout, and some people lose slowly at first and pick up pace afterwards. On average, people lose 20-25 pounds.
What should I do if I experience adverse effects from obesity medications?
In most cases, it is recommended to stop the medication and reach out to your physician, but some medications need to be tapered off. Regardless, it is crucial to notify your physician immediately.
Why can’t I lose weight, and why does it keep coming back?
The ability to lose weight and to keep it off depends on many factors. There are factors that cannot be physically controlled like genetic predisposition, slowing metabolism, menopause, the brain’s threshold to maintain a certain weight, medications (i.e. anxiety, depression, steroids), and other medical conditions. Factors that can be controlled are lifestyle changes in regards to diet and exercise.
No matter the intervention (surgical, medical, lifestyle), weight tends to keep coming back if these changes aren’t maintained.
Why can’t I use medications like Ozempic, Mounjaro, and Trulicity?
These medications, although similar to medications like Wegovy and Saxenda, are only approved for type 2 diabetes.
How much weight will I lose?
It varies among people but typically 20-25 pounds is lost on just weight loss medications alone. But with the addition of lifestyle changes, it is possible to lose more.
It is very important to set a weight loss goal. If you are overweight or have obesity, losing even 5 percent of your body weight can make a significant difference in your overall health.
Can I use these medications in combination?
Yes, but the particular combination that is most suited to your needs should be discussed with your physician.
What can I do if my medications aren’t covered by insurance?
Qsymia (Phentermine-topiramate) and Contrave (Bupropion-naltrexone) have programs where they can be purchased directly from the company for an out-of-pocket cost. Also, medications like Adipex (Phentermine) may have discount coupons from the manufacturer or through discount coupon sites like GoodRx. But for medications like Wegovy (Semaglutide) and Saxenda (Liraglutide), there are no such programs and they would have to be covered by insurance.
How long can I stay on these medications? Are they safe?
Medications like Wegovy, Saxenda, Qsymia, and Contrave can be used for long periods of time because they are approved for long term use. These medications are modeled after medications that people take life-long for other medical conditions and have long- term data behind them. Every medication has its own side effects, and should be monitored closely under a physician’s care.
Sources
General Information:
www.aace.com/patient-journey/obesity
www.endocrine.org/patient-engagement/endocrine-library/obesity
All Medications:
medlineplus.gov/druginformation.html
www.aace.com/patient-journey/obesity
Specific Medications:
Qsymia: qsymia.com
Contrave: contrave.com
Adipex: adipex.com
Lomaira: lomaira.com
Saxenda: saxenda.com
Wegovy: wegovy.com
Plenity: myplenity.com
Side Effects:
Information sourced from UpToDate.com as well as the sources listed above.
ObsiQ is created and developed by Aishwarya V - PHS, NJ