For people who have not had success with lifestyle interventions (diet & exercise) to lose weight, treatment with medication may be appropriate, to be used in conjunction with ongoing efforts to change from a lifestyle perspective. In addition to the two medications currently available (Sibutramine (Meridia) and Orlistat (Xenical)), there are at least three new medications that are in the final stages of research, and may become available soon:
•Qnexa: This medication incorporates low doses of two previously approved prescription medications: the diet drug phentermine, and topiramate, which is used to treat epilepsy and chronic migraines. Phentermine reduces appetite, and is occassionally used alone to assist with weight loss in the short term (3 months). Topiramate increases the sense of fullness.
In two separate studies, the mean weight loss was 13.2% (30 pounds) and 14.7% (37 pounds) for patients who were treated with full-dose Qnexa for 56 weeks. When people who didn’t complete the trials are included, the percentage of total weight lost drops to 10.4% to 11%.
•Lorcaserin: It works by stimulating serotonin receptors in the brain, thereby decreasing appetite. Patients who stayed on lorcaserin combined with lifestyle changes for one year lost an average of 17 pounds. About two-thirds of lorcaserin patients lost at least 5% of their body weight; about a third of those who took the placebo and made lifestyle changes accomplished this. The most responsive 25% of patients lost an average of 35 pounds.
•Contrave: This medication combines two drugs already on the market — bupropion, an antidepressant and smoking cessation medication (also known as Zyban or Wellbutrin SR), and naltrexone, currently used for alcohol and opioid addiction. It works to fight food cravings and improves the ability to control eating. The research shows patients lost about 6% to 9.3% of their starting weight in a year on the medication.
Medical therapy for weight loss can be considered for individuals who have a BMI of 30 or more, or a BMI of 27 or more with complications of obesity such as diabetes, sleep apnea, or high blood pressure. (You can calculate your BMI at www.drsue.ca using the ‘BMI Calculator’ in the right hand column!) Important considerations for drug treatment for obesity include:
- Medications to treat obesity generally result in only a modest weight reduction. However, this weight reduction can be twice as much when combined with changes in lifestyle (healthier food choices, portion control, and exercise!).
- Currently approved weight loss drugs have 2-4 years’ of safety data. In other words, we do not know what the effects of taking such medications for 10 years might have, and therefore, they should not be used indefinitely. This has important implications, as studies consistently show that once a medication for obesity treatment is stopped, the vast majority gain the weight back.
- All medications have risks and the potential for side effects, and these should be discussed thoroughly by your doctor if drug therapy is being considered. Drug treatment for obesity is available only by prescription from your physician, and should never be undertaken without medical (MD) supervision.
In my opinion, there is certainly a role for drug treatment of obesity, and it can be of great help to some people. The key to success is to view drug treatment as a kick start to weight loss, in combination with a permanent alteration of lifestyle habits, primarily geared towards reducing your caloric intake to 500 calories per day less than what you need. (You can calculate your daily caloric requirements at www.drsue.ca using the Basal Metabolic Rate (BMR) Calculator in the right hand column.)
Once 10-20 pounds are shed, and with an extra spring in your step, you can then ramp up the exercise (under the guidance of your physician) to increase your caloric expenditure. With these new diet and exercise changes solidly adopted into your life, the drug therapy can then be phased out. Obesity is a lifestyle problem for most people – and as such, the permanent solution lies in lifestyle too!