More threads by ^^Phoenix^^

I just liked how matter of fact this is and I remember having a question about it:

Weight Loss Drugs: How Much Do Diet Pills Help?
By Kathleen M. Zelman, MPH, RD, LD

The truth about weight loss medications and supplements.

"Clinically proven to help you lose weight without being hungry or working out for hours at the gym!"​

You’ve seen the ads promising successful weight loss by taking diet drugs or weight loss supplements, but do they really deliver results? Could weight loss medications and over-the-counter supplements really help to reverse the obesity epidemic?

Experts who spoke to WebMD agreed that there's no such thing as a quick fix or magic bullet when it comes to losing weight. Weight loss medications (not to be confused with dietary supplements) can help you lose weight, but only if you also cut calories and get moving. And effective weight loss, they say, is slow and gradual -- anywhere from 1/2 to 2 pounds per week, even with the help of diet drugs.

"Weight loss medications can be modestly effective, and enhance weight loss by 8%-10%, but medication does not work for everyone," says Robert Kushner, MD, a professor of medicine at Northwest University. Kushner estimates that about a third of his patients respond well to medication. But he points out that drug therapy is only one part of a lifestyle that also includes a healthy eating plan, regular exercise, and behavior modification.

Louis Aronne, MD, director of the comprehensive weight control program at New York Presbyterian Cornell Weill Medical Center, agrees. "Medications can really make a difference for some people, but it must be part of a complete lifestyle that includes diet and exercise," he says.

One problem, says Aronne, it is that there are simply not enough medications to choose from. "We have numerous medications for conditions like high blood pressure, but when it comes to treating obesity we only have a few, and we could use 5-10 different types of weight loss drugs," he says.

Weight Loss Drugs and How They Work
There are two basic types of weight loss drugs -- prescription drugs, which have been around for years, and now, with the release of Alli, over-the-counter medication. Other over-the-counter weight loss remedies are considered dietary supplements; they do not undergo the same type of FDA approval process as drugs.

"Approved weight loss drugs must prove they are safe and effective with strong scientific evidence in order to pass the stringent FDA approval process," says Aronne, former president of the North American Association for the Study of Obesity (NAASO).

In the prescription drug category, there are basically three choices, Xenical (orlistat), Meridia (sibutramine), and phentermine.

Xenical (orlistat) is a fat blocker that prevents fat from being completely absorbed in the gastrointestinal tract. Prescription strength is 120 milligrams; over-the-counter Alli is the same drug at half strength, or 60 milligrams. Fat blockers reduce fat absorption and, as a result, some people are plagued with oily discharge, fatty stools, gas, and/or inability to control bowel movements. These side effects are the result of the fat not being absorbed by the body. Eating a low-fat diet reduces the risk of potential side effects. But if your diet is already low in fat, you may see less of an impact from the medication, as there is less fat to block.

Xenical or Alli is safe for almost anyone because the drug is not absorbed, says Kushner. "I frequently prescribed it to cardiovascular patients because it is so safe," he says. Patients must be willing to stick to a low-fat diet. These drugs have a built-in feedback system. "If you eat a high-fat diet, you will experience the side effects, so to avoid the unpleasant effects, you need to reduce the fat in your diet," says Aronne.

Not only do these drugs block fat, they have the potential to block other nutrients. "Take a once-daily multivitamin mineral for nutritional insurance to help compensate for any losses and don’t take it at the same time as the medication," says Dawn Jackson-Blatner, a spokesperson for the American Dietetic Association.

Meridia (sibutramine) helps reduce hunger by working on the appetite control center in the brain that makes you feel full. "Meridia can help add 5%-10% additive weight loss that you would not get with diet and exercise alone" says Aronne. Kushner prescribes Merida to patients who struggle with cravings and have trouble knowing when to stop eating. Aronne says that younger patients who are at a low risk for heart disease are good candidates. Side effects include dry mouth, constipation, and insomnia. Meridia should not be used by anyone with cardiovascular risk factors. "We recommend regular blood pressure checks for anyone on Merida," says Blatner.

Phentermine is generic, the least expensive of the medications, and has been on the market the longest. Once a part of the famed fen-phen combination weight loss drug, Phentermine works to decrease appetite. It is the most widely used weight loss drug. While it's officially approved only as a short-term drug, some doctors use it as long term therapy. "I use phentermine for people with strong appetites. [It] seems to work best on reducing hunger and the number of eating episodes. I also like it because it is generic, and inexpensive for patients who do not have insurance coverage," says Kushner. Side effects may include depression, insomnia, increased blood pressure, irritability, and nervousness.

While these are the only medications approved for weight loss, some people also lose weight on prescribed medications used to treat other conditions such as depression, seizures, and diabetes.

Insurance coverage of these weight loss medications varies. Some companies will cover them completely, some partially, and some not at all.

Over-the-Counter Weight Loss Supplements
Dietary supplements should not be confused with weight loss medications. Most experts give little credence to the weight loss remedies that line drugstore shelves. "There is a bewildering array of weight loss dietary supplements, but the sad fact is, there is no credible medical evidence that the supplements are safe, effective, and perform the way they claim," says Aronne.

Even so, many people plunk down their money. Promises from manufacturers range from reduced appetite to increased metabolism. But these claims are loosely regulated, and if they sound too good to be true -- chances are, they are. "It is not as simple as many of the ads claim, and invariably what happens is patients try the supplements, they don’t deliver as promised, and patients gain another notch on their failure belt," says Kushner.

Blatner suggests talking to your doctor or a registered dietitian before buying supplements. "Wouldn’t you rather take an FDA-approved medication than take the risk of choosing an over-the-counter weight loss remedy that may not be safe or effective?" she asks.

The Today show nutritionist, Joy Bauer, RD, tries to inspire her clients to lose weight the old-fashioned way. "Very few of my clients rely on supplements or drugs, and my advice is to find the natural health benefits in food," she says. "It is much better to drink a hot cup of green tea that is soothing, relaxing, gives you something to do with your hands and mouth, and delivers the benefits [of green tea] in a much better form than taking a pill."

Who Can Use Weight Loss Medications?
Not everyone is a candidate for diet drugs.

"About one-third of my patients are on weight loss drugs, but they don’t start off that way," says Kushner. "The initial approach is to change their lifestyle, and after about 4-6 months of being engaged in a healthy lifestyle, if they are not getting results of 1- to 2-pound loss per week, we consider drugs." He says another third of his patients have surgery, and the last third are successful with what he calls "lifestyle medicine."

So who does do well on weight loss drugs? Before prescribing drugs, experts look at whether patients are eating a variety of healthy food, controlling portion sizes, using strategies to monitor and plan their meals, adhering to reasonable calories goals, and getting exercise. If the traditional approach to weight loss is not working, drugs are an option.

But don’t think that if you are 5 pounds overweight, you are going to be prescribed weight loss medication. "We follow the NHLBI [National Heart, Lung and Blood Institute] guidelines that patients must have a BMI of 27 along with other complaints, or a BMI of 30, before using drug therapy," says Aronne, editor of The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults.

Even when a patient meets the criteria and takes the drugs as an adjunct to a healthy lifestyle, there is no guarantee they will work. "We can usually tell who will be a responder in 4-6 weeks," Blatner says.


i think all diet pills should only be prescribed by a dr. after a thorough evaluation of an individual.

i also think to use diet pills, a BMI should be over a certain number.

too many people use them and abuse them..and become addicted or get really sick.

my sister is contemplating taking some kind of diet pill/drink to lose 5 lbs.

it made me laugh because that is so not the reason to even take a diet pill..and 5 measly pounds...she could easily do it if she exercised a few times a week instead of sitting on the couch after work every day.

and the whole diet pill thing just upsets me anyway, because i'm recovering from anorexia, and i don't like anyone i know, to even think about taking them..esp. when they aren't severely, or even moderately overweight.
I really don't know.

But I can tell you one way in which they DO definitely work... and that is, they can burn a hole in your pocket if you become dependent on them.

Daniel E.

Prescription medications approved to treat overweight and obesity​

Weight Management MedicationApproved ForHow It WorksCommon Side EffectsWarnings
orlistat NIH external link(Xenical)

Available in lower dose without prescription (Alli)
Adults and children ages 12 and olderWorks in your gut to reduce the amount of fat your body absorbs from the food you eat
  • diarrhea
  • gas
  • leakage of oily stools
  • stomach pain
  • Rare cases of severe liver injury have been reported
  • Avoid taking with cyclosporine NIH external link
  • Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat
phentermine-topiramate NIH external link(Qsymia)Adults
  • A mix of two medications: phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches
  • May make you less hungry or feel full sooner
  • constipation
  • dizziness
  • dry mouth
  • taste changes, especially with carbonated beverages
  • tingling of your hands and feet
  • trouble sleeping
  • Do not use if you have glaucoma or hyperthyroidism
  • Tell your health care professional if you have had a heart attack or stroke, abnormal heart rhythm, kidney disease, or mood problems
  • Do not take if you are breastfeeding
naltrexone-bupropion NIH external link(Contrave)Adults
  • A mix of two medications: naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking
  • May make you feel less hungry or full sooner
  • constipation
  • diarrhea
  • dizziness
  • dry mouth
  • headache
  • increased blood pressure
  • increased heart rate
  • insomnia
  • liver damage
  • nausea
  • vomiting
  • Do not use if you have uncontrolled high blood pressure, seizures, or a history of anorexia or bulimia nervosa
  • Do not use if you are dependent on opioid pain medications or are withdrawing from drugs or alcohol
  • Do not use if you are taking bupropion (Wellbutrin, Zyban)
liraglutide NIH external link(Saxenda)

Given daily by injection
Adults and children ages 12 years and older
  • Mimics a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake
  • At a lower dose under a different name, Victoza, this drug was FDA-approved to treat type 2 diabetes
  • nausea
  • diarrhea
  • constipation
  • abdominal pain
  • headache
  • increased heart rate
  • May increase the chance of developing pancreatitis
  • Has been found to cause a rare type of thyroid tumor in animals
semaglutide (Wegovy)7

Given weekly by injection
  • Mimics a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake
  • Under different names and dosages, this drug was FDA-approved to treat type 2 diabetes as an injectable medication (Ozempic) and as an oral pill (Rybelsus)
  • nausea
  • diarrhea
  • vomiting
  • constipation
  • abdominal (stomach) pain
  • headache
  • fatigue
  • Do not use in combination with other semaglutide-containing products, other GLP-1 receptor agonists, or other products intended for weight loss, including prescription drugs, over-the-counter drugs, or herbal products
  • May increase the chance of developing pancreatitis
  • Has been found to cause a rare type of thyroid tumor in animals
setmelanotide (IMCIVREE)

Available by injection only
People ages 6 years and older with obesity due to three specific rare genetic conditions only
  • May reduce appetite and increase feeling of fullness
  • May increase resting metabolism (how the body burns calories)
  • Although it can help a person lose weight, it does not treat the genetic defects
  • injection site reaction
  • skin darkening
  • nausea
  • disturbance in sexual arousal
  • depression and suicidal ideation
  • risk of serious adverse reactions in neonates and infants with low birthweight, owing to benzyl alcohol preservative
Only for people with any of these ultra-rare genetic diseases, confirmed by genetic testing
  • proopiomelanocortin (POMC) deficiency
  • proprotein convertase subtilisin/kexin type 1 (PCSK1) deficiency
  • leptin receptor (LEPR) deficiency
Do not use while pregnant or breastfeeding.
(Other medications that curb your desire to eat include)
  • phentermine
  • benzphetamine
  • diethylpropion
  • phendimetrazine
  • Increases chemicals in your brain to make you feel you are not hungry or that you are full
  • Note: FDA-approved only for short-term use—up to 12 weeks
  • dry mouth
  • constipation
  • difficulty sleeping
  • dizziness
  • feeling nervous
  • feeling restless
  • headache
  • raised blood pressure
  • increased heart rate
  • Do not use if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma
  • Tell your health care professional if you have severe anxiety or other mental health problems

Daniel E.

The greatest mean difference of percent body weight change was seen with semaglutide (-11.41%, 95% CI -12.54 to -10.27) and phentermine-topiramate (-7.97%, 95% CI -9.28 to -6.66). However, the drugs with the greatest risk (odds ratio) of discontinuation due to adverse events were semaglutide (Odds ratio 2.45), naltrexone-bupropion (2.69), and phentermine-topiramate (2.40).

Daniel E.
My new primary care doctor, who specializes in weight loss, recently prescribed me phentermine (listed above), which is a stimulant to help decrease appetite. It has been a mood / energy booster so far. As a result, I have already been exercising more than usual. I have also had less appetite but not unusually so. (Being on a stimulant will also be helpful later this month when I will have to do all the housework by myself for about ten days :))

My doctor performed an EKG before prescribing, and there are monthly follow-up appointments. Phentermine is mostly for short-term use since the effects are greater in the first few months. The out-of-pocket cost for phentermine is only about $20.

Some of the other weight-loss medications are very expensive (like $1,400 a month for Wegovy) and are not covered by any insurance, though some Americans have been getting them relatively cheap from Canadian pharmacies.
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