Weight Loss Medication: How Do They Work and Which Are Worth Trying?
Takeaways
Roughly half (44%) of the world's 4.6 billion adult population tried to lose weight last year. Unfortunately, less than 3% succeeded. And if current trends are any indication, these numbers are only expected to worsen in the years to come.
Maybe you were one of those that tried. But no matter how hard you exercised or how strict your diet, the scale wouldn't budge.
Don't worry; it's not you but your genetics because an often ignored component of weight loss is DNA. Some studies show that genes are responsible for 80% of body weight. While your genes may impede your weight loss journey, that does not mean there's nothing you can do about it.
Weight loss medications work because they act on a biological level. In other words, when coupled with a healthy diet and regular exercise, weight loss medication can help you lose weight effectively and safely, overcoming biological factors. And at the same time, enable you to keep it off.
For some people, perhaps taking medication feels like the opposite of how you want to go about your weightloss journey. Dr Sue-Anne Toh, NOVI Health’s CEO and co-founder, thinks of medication as creating calming waters where you can swim and reach your destination with more ease. Otherwise, it’s like swimming when the current and waves are working against you.
In this article, we explore this further.
Do Weight Loss Drugs Work?
There is no denying that lifestyle interventions such as diet and exercise are effective weight loss treatments. But they may not be equally effective for everyone because each individual has a unique genetic makeup. They can also be challenging to stick to long-term since life invariably gets in the way, reversing any progress made
While lifestyle modifications are the cornerstone of any weight loss program, studies show that regularly exercising and eating healthily leads to less than a 5% reduction in body weight on average. But when combined with weight loss drugs, these numbers rise to more than 10%. Similarly, medical weight loss treatments produce a 9% increase in weight loss for users already on a healthy diet and exercise regimen.
This is because medications work by resetting the bodys' metabolic pattern. In other words, they lower appetite, regulate digestion, and alter the body's response to food leading to better, more sustainable weight loss.
Not just that, they also improve the users' cardiometabolic profile — lowering blood pressure, insulin resistance, and blood fat levels. This, in turn, reduces the risk of heart disease and other chronic illnesses.
Who Is A Candidate?
In general, anyone who hasn't succeeded at losing weight with diet and exercise alone is a candidate for weight loss medication. More specifically, doctors at medical weight loss clinics may prescribe weight loss medications if you've tried to lose weight but:
- Have a body mass index (BMI) of over 30 kg/m2
- Or a BMI of more than 27.5 kg/m2 with concurrent obesity-related comorbidities
What You Should Know About Medical Weight Loss Treatments
First, it's essential to realize that obesity is a chronic condition. Thus, a multi-prong approach that includes weight loss medications and a comprehensive nutritional and exercise plan works best for sustainable, long-term results. Think of weight loss drugs as an adjunct to lifestyle interventions — not a replacement.
Second, because everyone’s body and DNA are unique, a drug that works for someone else may not work for you. This is why your doctor may change your medication if you haven’t lost at least 5% of your body weight after six months on the full dose of a drug.
Lastly, like other drugs, weight loss drugs are not without side effects. Mild adverse effects such as nausea and gastrointestinal upset are common; however, these often decrease over time. More severe side effects can also occur, but luckily they are rare.
Types of Weight Loss Drugs
To date, The FDA has approved five weight loss drugs for long-term use. These are:
Orlistat (Xenical, Alli)
Phentermine-topiramate (Qsymia)
Naltrexone-bupropion (Contrave)
Liraglutide (Saxenda)
Semaglutide (Wegovy, Ozempic, Rybelsus)
Most of these drugs — except for orlistat — work by lowering appetite and promoting feelings of fullness (satiety). Orlistat works by decreasing fat absorption. GLP-1RAs (liraglutide such as Saxeda; and semaglutide such as Wegovy, Ozempic and Rybelsus) can help to achieve good blood sugar control in people with diabetes.
Orlistat (Xenical, Alli)
Orlistat functions as an inhibitor of the pancreatic enzyme lipase — which breaks down fat molecules in food so that the body can absorb them. Naturally, without pancreatic lipase function, the body cannot absorb fat. This, in turn, helps reduce weight.
Remember that orlistat can cause diarrhea, mainly if your diet is rich in fat. Thus, doctors recommend taking a low-fat diet when on the drug.
Phentermine-topiramate (Qsymia)
The combination of Phentermine-topiramate works as an effective medical weight loss treatment by suppressing appetite. Phentermine achieves this by triggering the release of the hormone noradrenaline. The mechanism by which topiramate — an anticonvulsant — lowers desire remains unknown.
Regardless, studies show Qsymia is an effective treatment, with users reporting a 6.6–8.6 kg weight loss over 12 months.
Bupropion-naltrexone (Contrave)
Contrave is a combination of two drugs: Bupropion and naltrexone. Individually, naltrexone works to treat alcohol and opioid dependence. In contrast, bupropion is an antidepressant that can function as a 'quit-smoking' aid.
Together, bupropion and naltrexone reduce food intake and increase the body's energy expenditure. They achieve this by triggering the body's satiety center (in the hypothalamus) to produce melanocyte-stimulating hormone (MSH), which regulates appetite.
GLP-1 Agonists: Liraglutide (Saxenda)
Glucagon-like peptide 1 (GLP-1) agonists are efficacious treatments for type 2 diabetes. But given their effectiveness in reducing body weight, the FDA has approved GLP-1 agonists for weight loss.
GLP-1 agonists function by replicating the effects of the hormone GLP-1, which the intestine produces in response to food. This boosts insulin production and decreases glucagon release. The net result is slower gastric emptying and greater feelings of fullness.
In other words, GLP-1 agonists:
Regulate appetite
Reduce cravings by overhauling the "hunger hormones"
Keep you satiated between meals
Studies show GLP-1 agonists also lower blood glucose levels by increasing insulin sensitivity. On top of that, they decrease blood pressure and reduce blood fat and triglycerides levels, thus improving the cardiovascular risk profile.
Crucially, user compliance is greater with GLP-1 agonists than other weight loss drugs. This is because of their once-weekly dosage and low risk of adverse effects. While nausea, vomiting, and diarrhea can occur, they reduce over time as the body adapts to the drug.
GLP-1 Agonists: Semaglutide (Wegovy, Ozempic & Rybelsus)
Some GLP-1RAs are approved specifically to promote weight loss. In Singapore, until recently, only liraglutide (Saxenda) was approved for weight loss. However, Wegovy (semaglutide) has also been approved for weight loss treatment in Singapore.
Semaglutide such as Wegovy, Ozempic and Rybelsus are not available over the counter. You will need to consult a doctor to assess whether the benefits outweigh any risks.
Studies showed that with Wegovy, patients achieved 5%–20% or greater weight loss. Further, Wegovy was found not only superior at reducing body weight compared with other antidiabetic drugs, but also cardioprotective.
*Results based on clinical trials.
Benefits of a Medically Supervised Weight Loss Program
Weight loss is achievable through many means. But maintaining results is often far more complex. That is why the typical weight loss pattern includes a sudden sharp decline in weight followed by a small plateau and then weight gain.
Studies show that more than 33.5% of people regain their lost weight within 12 months. This is because sustained weight loss requires ongoing clinical supervision, specific counseling, and regular medication to support healthy lifestyle behaviors and positive weight regulation on a biological and genetic basis.
Medically supervised weight loss programs offer precisely that, which is why participants in the programs lose more of their body weight. On top of that, the weight loss persists for years to come.
