ASK DR. K:
Weight-loss drugs not for the mildly overweight,
DEAR READER: If you are only mildly overweight or just want to lose a few pounds to improve your appearance, then weight- loss drugs are not for you. On the other hand, if your health is at risk and you haven’t been able to lose weight through diet and exercise, drug therapy may increase your chance of success.
There are a handful of FDA-approved weight-loss drugs on the market today. One is available over-the-counter; the others are prescription only. When I was a medical student, virtually none of them were available. The growing epidemic of obesity has led to the development of many drugs that can be helpful. None is a “magic bullet”; none melts the fat off of you while you’re watching TV.
These drugs promote weight loss in different ways. A drug called orlistat reduces the amount of fat your body absorbs from the food you eat. Other drugs suppress your appetite, help you feel full and ramp up your metabolism. The drugs that work this way have long, hardtopronounce medical names: lorcaserin, phentermine, diethylpropion, benzphetamine, phendimetrazine, bupropion, topiramate, zonisamide.
Several drugs for Type 2 diabetes appear to also help with weight loss, when combined with lifestyle changes: metformin, pramlintide, exenatide, liraglutide.
It’s ironic that the names of each of the drugs that can help with weight loss are themselves quite a mouthful.
When deciding whether to recommend weightloss drugs to my patients, I consider their body mass index ( BMI). BMI estimates a healthy weight based on height. (Refer to the BMI chart I’ve put on my website, AskDoctorK. com, to determine your BMI.)
You should consider taking a weight-loss drug only if you:
Have a BMI of 30 or higher, or
Have a BMI of 27 or higher and also have one or more weight- related health problems, such as Type 2 diabetes or high blood pressure.
Before you start a weight-loss drug, consider why you overeat. For example, do you overeat because of stress, bad habits or emotional issues? If so, you may benefit less from medication and more from psychotherapy or behavioral therapy. On the other hand, if you overeat because of hunger, then weight-loss drugs are more likely to help.
Over the years, several weight- loss drugs have been taken off the market because of safety concerns. It can take time, and lots of people taking a new drug, before any safety issues become apparent. Most of the drugs now available have not been on the market very long, so talk to your doctor about your individual risks and benefits.
Finally, bear in mind that you should use weight- loss drugs only in combination with diet and physical activity. To lose weight over the long term, you need to recognize and change the behaviors that led to your weight gain. Otherwise, any weight you lose is likely to return.