What to Know About Weight Loss Drugs

By Lizzie Streit, MS, RDN, LD 

Anti-obesity medications are getting more attention these days, especially with the Food and Drug Administration’s (FDA) approval of semaglutide (Wegovy) for long-term use. You may have heard about them from a friend, in the news, or maybe even as a recommendation from your doctor. 

It’s true that these medications can have promising results for some people struggling to manage obesity and lose weight. However, like with any medication, there are side effects and other aspects to consider. 

Read on to learn more about how weight loss drugs work, their possible benefits, and potential downsides. 

What are weight loss medications? 

The FDA currently approves five drugs for long-term use to treat overweight and obesity, meaning people can take these medications indefinitely as long as they are not experiencing side effects. 

The mechanism of action for inducing weight loss varies by medication. Orlistat (Xenical), one of the medications available both over the counter and by prescription in the form of capsules, targets enzymes in the gut to reduce fat absorption from food. Phentermine-topiramate (Qsymia) and naltrexone-bupropion (Contrave) both work by reducing appetite and are also taken orally. 

Liraglutide (Saxenda) and semaglutide (Wegovy), drugs known as glucagon-like peptide-1 (GLP-1) agonists, decrease appetite by targeting areas of the brain that regulate intake. These medications are also used to treat type 2 diabetes under different names, forms, and dosages. Liraglutide and semaglutide are administered as injections under the skin in the stomach, thigh, or upper arm once daily and once weekly, respectively. 

The FDA has also approved some appetite-curbing medications for short-term use, defined as up to 12 weeks. It’s unclear whether these would be safe and effective if taken for longer periods of time. 

Possible Benefits 

Weight loss medications have shown promising results as a treatment for overweight and obesity. According to the National Institutes of Health (NIH), people who took prescription drugs for weight loss in addition to making lifestyle changes lose 3 to 12% more weight than those who only made lifestyle changes after one year. GLP-1 agonists, like the aforementioned liraglutide and semaglutide, appear to be some of the most effective medications. 

Possible Downsides 

While prescription anti-obesity medications may help with weight loss, they also come with possible downsides. Side effects vary by the type of drug and may be different for each person.  

Some of the most common side effects include: 

  • Diarrhea 

  • Constipation 

  • Nausea 

  • Vomiting 

  • Stomach pain 

  • Headaches 

  • Dry mouth 

  • Increased heart rate 

In most cases, side effects are mild to moderate and may improve with continued use of the medication. Depending on the medication, there is potential for serious side effects too. Orlistat has been connected to rare cases of liver injury, while naltrexone-bupropion may cause mental health changes such as worsening depression or anxiety and suicidal thoughts. 

In addition, these medications may not be suitable for certain populations. They are not recommended for women who are pregnant or planning to become pregnant, and many should not be taken while breastfeeding. People who have a history of certain health conditions or take other medications may not be good candidates for taking weight loss medications, depending on the drug. It is vital that you discuss your options with your doctor and fully understand the possible benefits and side effects of weight loss medication relevant to your unique situation. 

Even if you and your doctor decide together that you should try a medication, weight loss is not guaranteed. If you do not lose weight in the first 12 weeks of taking a medication, your health care provider may consider stopping the drug and changing your treatment plan. 

Another possible downside is cost. These medications can be expensive and are not always covered by insurance. Before starting a weight loss medication, consider discussing coverage with your health insurance provider so that you are aware of what’s covered and any associated costs. 

The Role of Healthy Eating and Exercise 

There are other pitfalls to consider when thinking about starting a weight loss medication. These drugs are not magic and cannot replace a healthy diet and regular physical activity. 

In fact, they are recommended as a supporting tool for those already engaged in a healthy eating and physical activity program or following a weight loss meal plan. Many people who struggle with losing weight through changes to diet and exercise alone find that weight loss medications are a game-changing tool. 

Keep in mind that even when combined with healthy eating and exercise, anti-obesity medications may not result in drastic weight loss. However, they may be helpful in losing 5 to 10% of starting body weight, which is considered clinically significant. A loss of 5% of total body weight has been associated with improvements in obesity-related health issues, such as high blood pressure or insulin resistance. 

It’s important to note that the benefits of most weight loss medications are dependent on long-term and indefinite use. When you stop taking the medication, you will likely regain some weight. Sticking with healthy eating and regular exercise may help you keep off the weight. 

Tips With or Without Medication 

Overall, it’s clear that weight loss medications can play a role in helping someone lose weight. They may be especially helpful for those who are struggling to drop excess pounds through healthy eating and physical activity alone. In most cases, side effects are mild and often outweighed by the possible benefits, but it largely depends on the person and type of medication. Always discuss your options with your healthcare provider to find out what path is best for you. 

Eating a nutritious, balanced diet and engaging in regular exercise will help you get the most out of taking a weight loss medication. Plus, these lifestyle habits are recommended for maintaining health regardless of whether or not you taking an anti-obesity drug or want to lose weight. 

Here are some top tips for staying healthy no matter where you are in your weight loss journey: 

  • Eat balanced meals: Build a plate with lean proteins such as chicken breasts or beans, complex carbohydrates like whole grains, and plenty of vegetables. Use healthy fats to prepare and add flavor to foods, such as topping a salad with avocado, roasting vegetables in olive oil, and dipping fruit in Greek yogurt. If you need help preparing healthy foods, consider meal prep services or diet meal delivery. 

  • Exercise regularly and/or throughout the day: Get in the habit of exercising most days through an activity that you enjoy, whether that’s a morning walk around the neighborhood, a lunch break jog, or weight lifting before dinner. Try exercise classes, group fitness programs with friends, or anything else that you find motivating. If it’s hard to get in a routine, don’t discount bursts of activity throughout the day. Take the stairs when you can, walk the dog more often, and park farther away from a store.  

  • Avoid smoking and excess alcohol use: If you need help quitting smoking, speak with your health care provider about available resources. Limit or avoid alcohol use and switch to non-alcoholic mocktails made from unsweetened seltzer water, a splash of juice, and fresh herbs. 

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Stef Keegan