Weight Loss Blog #2: Weight Loss Medication Overview - A Review of Rising Medication Stars Including Ozempic, Saxenda, Wegovy, and Contrave

As we discussed in our first blog of this series, losing weight and keeping it off can be challenging.  Ideally, we like to start by focusing our patients on lifestyle changes - specifically diet and exercise. While there is no one-size-fits-all approach to nutrition, in our experience, a plant or whole foods-heavy diet with at least some consciousness around carbohydrates and varying degrees of intermittent fasting can be the most effective for weight loss. Patients differ in their tolerances and responses to these interventions based on many things including their age, sex, genetic makeup, and health history. However, a dedication to a healthy diet combined with a regular exercise routine can bring about positive results.

The following resources inform my treatment of patients:

• Eat Fat, Get Thin, Mark Hyman, MD

• The Obesity Code and Life in the Fasting Lane, Jason Fung, MD

• Women, Food and Hormones, Sara Gottfried, MD

• The Whole 30

You can also review the blogs we’ve developed on Intermittent Fasting:

• Intermittent Fasting: A Highly Successful Approach to Weight Loss

• Intermittent Fasting Part 2: A Tool For Sustainable Weight Loss

• Intermittent Fasting Part 3: Myths & Misconceptions

For those patients for whom diet and lifestyle interventions are not sufficient, strategic use of medications can help contribute to successful weight loss.

WEIGHT LOSS MEDICATION OVERVIEW

There are several safe, effective medications available for prescription that, when combined with lifestyle modifications, can help contribute to weight loss. These medications can be helpful for a motivated patient who needs some momentum or assistance with weight loss. We provide more detailed information on our Weight Loss with Semaglutide page and you can also learn about our own Medical Weight Loss program here.

• GLP-1 Agonists - These injectable medications, also known as glucagon-like peptide-1 (GLP-1) receptor agonist drugs, mimic the action of a hormone called glucagon-like peptide 1.  The drug stimulates the secretion of insulin and slows the release of glucagon, influencing blood sugar control. GLP-1 agonists can slow stomach emptying, impacting hunger and satiety signaling. They are also thought to affect ghrelin and leptin, hormones that dictate appetite and cravings. GLP-1 agonists have been approved for diabetes since 2005 and more recently approved by the FDA for weight loss. Semaglutide (aka Wegovy™ or Ozempic™) and Liraglutide (aka Saxenda™ or Victoza™) have both been approved for weight loss in recent years.
  Studies show that there is a direct correlation between GLI-1 agonists and weight loss. In clinical trials of Wegovy as an adjunct to lifestyle modification, participants lost an average of 15 percent of their body weight – with more than half the people treated with Wegovy losing more than 15 percent of their starting weight - up to five times the average weight loss seen with traditional diet and exercise plans.

• Contrave - Contrave is an oral pill that combines two medications, bupropion HCl and naltrexone HCl, that together reduce hunger and control cravings. These medications act on two parts of the brain: the hypothalamus (hunger center) to reduce hunger and the mesolimbic reward system to help control cravings. Three different clinical studies demonstrated that patients taking Contrave, along with diet and exercise, lost 2-4x more weight than with diet and exercise alone.

• Stimulants -  There are some amphetamine-like prescription medications used to suppress appetite - which assist weight loss efforts by decreasing hunger or making people feel full longer.
  
  Phentermine and Topomax (Adipex-P, Lomaira, Suprenza, Qsymia) - Phentermine is a prescription medication related to Amphetamine. While the exact way phentermine reduces appetite is unclear, it is thought to act by increasing neurotransmitter levels in the brain. These neurotransmitters are three chemical messengers (norepinephrine, serotonin, and dopamine) and when they increase, feelings of hunger decrease. It is given for a short period (not more than 12 weeks) due to its potential side effects if taken long-term - including high blood pressure, palpitations, inability to rest, and insomnia. It is indicated that obese patients have a body mass index of more than 30 and are at risk for cardiovascular diseases due to their weight. Phentermine can also be combined with Topiramate (aka Topomax) in a drug called Qsymia - which has been approved for long-term use. Topiramate is a migraine medication that is also thought to impact hunger signaling and is used most often in combination with phentermine. 

SURGICAL WEIGHT LOSS OPTIONS

People generally turn to Bariatric (weight loss) surgery when changes to diet and exercise don't work - or when serious health problems related to weight become increasingly threatening.  Surgical options essentially change the patient’s digestive system -  some procedures limit how much one can eat, others reduce the body’s ability to absorb nutrients, and a few procedures do both. Weight loss surgical options include gastric bypass, gastric sleeve, and lap band. We generally consider these a last resort option and hope that patients considering this intervention have already sought out the support of a weight loss specialist and attempted lifestyle modifications supported by weight loss medications.

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