You may have heard in the news there are some new prescription weight loss medications on the scene that have been recently approved by the Food and Drug Administration (FDA). If so, you are right, and they represent new, valuable tools your doctor can employ in the battle against weight gain and obesity. So what are these new drugs and can they be helpful to you specifically?
The first of the new drugs to be approved is called Belviq, or Lorcaserin, and this is a prescription drug that is referred to as a serotonin (5-HT2C) receptor agonist, which means it acts like the neurotransmitter serotonin and boosts satiety. In the largest study, a phase 3 randomized controlled trials, over 47% of patients on Lorcaserin (Belviq) lost at least 5% of their body weight at one year under a medically supervised weight loss program. Only 7% of patients dropped out due to side effects, the most common of which was headache.
The second recently approved weight loss medication is now called Qsymia, formally called Qnexa. It is a combination of two drugs that have shown effectiveness in weight loss, Phentermine and Topiramate. Phentermine is an appetite suppressant that functions as a mild stimulate along the lines of caffeine. It has been around for decades, and is proven mildly effective in producing weight loss with very few side effects. When side effects are present they may include nervousness, jitteriness or mildly elevated blood pressure and heart rate. It is not habit forming, and is not associated with valvular heart disease (that was fenfluramine, the other half of “Fen-Phen”). Topiramate is an anti-seizure drug that has been effective in compulsive eating disorders and obsessive compulsive behaviors generally, so the combination drug holds promise as an effective weight loss medication. In a two year, randomized controlled trial, the drug Qsymia led to 10% sustained weight loss, and appeared also to resolve type 2 diabetes in some patients. The most common side effects were respiratory infection, constipation, tingling, sinus infection, and dry mouth. Around 4% of people discontinued use of the medication due to adverse events.
The third entry to the weight loss medication arsenal is Contrave. Contrave is a medicine that contains two compounds (naltrexone HCI and bupropion HCI) that in combination have shown effectiveness in weight loss. The intent of the medication is to take away hunger and food cravings by influencing the satiety center of the brain. How the combination of the two drugs interact with the brain (naltrexone HCI and bupropion HCI) is not entirely understood. But it is know that bupropion HCI assists the brain in lessening a person’s appetite. There are definitely some side effects, so please speak with your physician about the use of this medication in conjunction with other prescriptions that have already been prescribed. In clinical trials that studied more than 4,500 people, the drug helped people keep off weight for up to a year (the length of the studies). On average, those who took Contrave for 6 months and combined it with a weight-management program lost 25 pounds. Those who were on placebo and the weight-management program averaged a 17-pound loss.
So who should consider using these new weight loss medications? Well, the Food and Drug Administration has approved these medications for use in anyone with a body mass index over 30, as well as in people with a body mass index of 27 or greater who have a comorbid condition such as high blood pressure, diabetes, or obstructive sleep apnea.
In our practice, Phentermine has already shown some effectiveness in boosting weight loss results in some individuals under a supervised weight-loss program. We expect that Qsymia will increase the effectiveness and, with proper supervision, be a useful adjunct treatment in the battle against obesity. Both Belviq and Qsymia resemble previously utilized drugs. These are evolutionary new medications rather than revolutionary. This means the mechanisms of action are familiar to physicians and the likely side effects are familiar and have been studied in randomized controlled trials. On the other hand, it means they are not “magic bullets.” To maximize successful weight loss, the individual must exercise, reduce calorie intake, and cut carbohydrates.
Dr. Sasse believes the new medications are helpful in a few specific circumstances.
- They are very helpful for patients who have struggled with plateaus in their medically supervised weight loss journey and need a boost to resume the downward weight trajectory.
- They are helpful in rebound weight gain. People who have experienced this problem know exactly how it feels to work hard to lose weight only to see the pounds rebound rapidly. Getting back on track requires a medically supervised plan that emphasizes protein and vitamin intake, as well as preservation of muscle mass with exercise. The addition of a weight-loss medication can be very helpful in controlling appetite and ensuring success.
- Pre-surgical weight loss. In this setting most patients are highly successful utilizing a medically supervised approach. It emphasizes liquid protein shake meal replacements, but in some cases prescription medications can boost success, leading to pre-surgical shrinkage of the liver, improved surgical safety, and successful pre-surgical weight loss.
- After Weight Loss Surgery. After weight loss surgery most people lose weight steadily and rapidly, but everyone at some point struggles to maintain or to continue losing pounds. Patients who have had weight-loss surgery and find themselves struggling to lose pounds, to move off a plateau, or to get “back on track” after some rebound weight gain can benefit from prescription weight loss medications, in addition to a medically supervised program.
Because obesity is such a serious disease, with its own complications, including the complications of diabetes, obstructive sleep apnea, hypertension, heart disease, lung disease, kidney disease, and degenerative joint disease, Dr. Sasse and his team take a very serious and individualized approach to weight loss and long-term health. The use of FDA approved weight loss medications enhances that effort.