The number of individuals in the US who are overweight or who are living with obesity has dramatically increased in recent years. People are exploring all avenues for diet and lifestyle changes, often with little success in losing weight. Enter weight loss medications, which have gained immense popularity as an accessible way to lose weight.
There are currently only seven medications that are FDA-approved for long-term use to treat overweight and obesity. These are:
- Orlistat (Xenical)
- Phentermine-topiramate (Qsymia)
- Naltrexone-bupropion (Contrave)
- Liraglutide (Sexenda)
- Semaglutide (Wegovy)
- Setmelanotide (IMCIVREE)
- Trizepatide (Zepbound)
You might be thinking, what about Ozempic? Ozempic (also semaglutide, like Wegovy) is FDA-approved, but only for treating type 2 diabetes. Physicians may prescribe drugs that aren’t FDA-approved specifically for overweight and obesity, like Ozempic, for ‘off-label use.’ This ‘off-label’ use could also be performed if someone is prescribed multiple medications at once or if they have been prescribed them for a longer period than what has been approved.
How do these medications work?
These medications work through a few different mechanisms depending on the specific one you’re prescribed. Generally speaking, these drugs act on the hormones controlling our appetite and food intake to reduce our appetite and make us feel fuller faster. Some may differ from this, like Orlistat (Xenical), which acts to reduce fat absorption from food in our diet, and Setmelanotide (IMCIVREE), which, in addition to reducing appetite, also tells our body to use more calories, further promoting weight loss.
How can you get them?
Physicians use BMI to indicate someone’s benefit from these weight loss medications. If you have a BMI of ≥ 30 or ≥ 27 and a weight-related health condition such as type 2 diabetes, you may be considered eligible for these medications. Eligibility is not always guaranteed, as some individuals may benefit from diet and lifestyle changes on their own before even being considered for these medications.
What should you know before starting these medications?
It is essential to consider that these medications are not a replacement for dietary changes and physical activity. Even though these medications are altering our body’s natural pathways to induce weight loss, diet and lifestyle changes still matter. Nutritious, balanced diets are necessary for adequate intake of carbohydrates, protein, fat, vitamins, and minerals, all of which are necessary for energy, muscle stores, proper digestion, and keeping our bodies functioning well as a whole. Furthermore, physical activity can help promote heart health and prevent chronic disease later in life. Physical activity has also been shown to benefit our immune system and mental health, making it an important incorporation into your lifestyle.
Research has shown that these medications work best when combined with diet and lifestyle changes. If you’re taking these medications for only a finite period, it is important to have a foundation for proper diet and lifestyle changes so that weight loss can be best maintained when coming off these medications.
Where does a registered dietitian fit into this?
Even though registered dietitians cannot prescribe these medications, they are still a vital part of your weight loss journey. Not all available medications in the market are recommended for long-term use. Research has shown that people who have completed their use of these medications are at risk for subsequent weight gain. This could be related to the biological processes returning to normal as we come off these medications or the lack of support to attain a balanced diet and lifestyle patterns. Working with a dietitian before, during, and after using these medications can help you to develop positive mindsets surrounding food and maintain behaviors that will help you in the long term.
Written by: Carolyn McHugh, Dietetic Intern
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