Battle for weight loss continues

Dear Dr. Roach: I am looking for advice on diet pills. I have tried everything. I eat well, go to the gym and walk, but my meniscus problem limits my walking speed. Since menopause, I have gained 30 pounds. I am so depressed, and my doctor has no sympathy. — A.R.

Difficulty losing excess weight is one of the greatest public health problems in industrial countries, and I’m not going to solve it here, but I’ll try to discuss principles of drug treatment for weight.

One critical issue is to look at any medications you are taking: Many can cause weight gain, and some, like beta blockers, often used for high blood pressure, are unrecognized by many doctors. Stopping medicines that predispose to weight gain is critical.

Depression is a predisposing factor to weight gain. Some lose weight with depression, but my experience is weight gain is much more common. Many anti-depression medicines cause weight gain.

Among medicines specifically for weight loss, most work either by decreasing fat absorption or by reducing appetite. They don’t really increase metabolism.

Orlistat prevents the body from absorbing some of the fat in the diet. The fat is then excreted through stool. This may cause many people to have gastrointestinal side effects. Orlistat caused people to lose about 7 pounds more than placebo.

There are several drugs that work on appetite. Liraglutide is a diabetes medicine that has been found to be helpful in overweight people even without diabetes. Metformin is another diabetes medicine that is sometimes used for weight loss. Lorcaserin (Belviq) is about as effective as orlistat, but with fewer side effects). Some weight loss experts use combination drugs. These have more significant risks.

It’s important to remember that medications are not a cure for being overweight.