Dr. Pamela Brandt is director of Obesity Medicine/Non-surgical Weight Loss at Inova. She is an internal medicine physician who is a diplomate at the American Board of Obesity Medicine.
In the United States, the struggle with weight is a pervasive issue, with almost one in three adults overweight and more than two in five battling obesity. A variety of factors from an individual’s unique genetic makeup, medication use, to food intake and activity habits can contribute to excess weight. But, with the evolution of weight loss medications, there are now many options to help patients lose weight in tandem with specific lifestyle changes.
So, who is eligible for prescribed weight-loss medications? This is based on Body Mass Index, which is a ratio of height and weight. Individuals with a BMI over 27 who have a comorbidity (weight-related medical condition), or a BMI of over 30 can be prescribed weight-loss medications by their health care provider. These medications are designed to control eating by controlling appetite.
While many people want to lose weight to improve their health, not all behaviors that cause weight loss are “healthy.” For some, these medications may significantly reduce appetite, but a patient should not avoid eating. In fact, if the body isn’t getting the nutrients it needs, it is more likely that a person will lose muscle instead of fat. Eating enough of the right nutrients, especially protein in the right amount, and exercising are important tools to minimize muscle loss. Losing muscle makes you more likely to have other health problems, less functional, and more likely to regain weight.
What Drugs Are Available and How Do They Work?
The weight-loss drugs that are currently approved by the Food and Drug Administration work in a variety of ways. Drugs with the active ingredient Orlistat, such as Xenical, block fat absorption in the intestine, leading to calorie loss through stool. Stimulants like Phentermine trigger a “fight or flight” response, reducing physical hunger. Another medicine called Contrave can help decrease food cravings and mental hunger. Injection medicines, such as semaglutide, liraglutide, and tirzepatide, mimic a hormone produced in the small intestine that signals satisfaction to the stomach and brain, thereby reducing hunger and promoting faster fullness.
Once patients begin a medication regimen, their provider will monitor them for any side effects or other adverse events and review interactions with other drugs.
New and Emerging Medications
There are many medications in development for weight loss. Many of them are also being designed to affect hormones in the gut that send a signal to the brain. There are also medicines that have different combinations of several of these hormones. Pill versions of weight-loss medication are also in development.
All medications that are FDA-approved for weight loss are required to show efficacy for approval. Medications that are not associated with at least the standard 5 percent weight-loss threshold generally do not receive approval. The newer medications are getting better in terms of average weight loss in studies. Wegovy (semaglutide) has an average weight loss of about 15 percent, and Zepbound (tirzepatide) has an average weight loss of around 19 percent. Fifteen to 20 percent is usually the goal in clinical practice, but even 5 to 10 percent weight loss improves health.
Long-term Usage Implications
Obesity is a chronic disease. That means that even when patients lose weight, their disease is not gone, so some may need treatment for the rest of their lives. As with other chronic diseases such as high blood pressure (hypertension), that treatment may change over time. Sometimes patients can manage their disease with lifestyle changes such as exercise, but sometimes they may need other tools, including more medications or surgical procedures.
Not every patient who takes medicine will lose weight, just as not every patient who stops medication will regain weight. Certain behaviors are associated with long-term weight maintenance after weight loss, such as exercise, monitoring weight and food intake, and behavioral support.
Weight Loss Can Lead to Better Health
Many patients’ overall health outcomes improve with weight loss, more specifically with loss of visceral fat, which is the fat that is inside and around our internal organs. This type of fat makes hormones that send and receive signals from other parts of the body and drives inflammation, which can lead to metabolic diseases such as Type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular disease, as well as many types of cancer. Decreasing this type of fat may help treat these diseases as well. Weight may impact a person’s ability to move around and do things they enjoy by placing more pressure on their joints and back. Losing weight can alleviate this pressure and allow patients to be more active.
It’s important to remember that the journey of weight loss is not the same for everyone. There are many options currently available for patients and health care providers play a pivotal role in guiding patients toward the most suitable treatment path, considering factors such as medical history, lifestyle, and personal goals.
For more information on weight loss services at Inova, visit inova.org/our-services/inova-weight-loss-services.
Feature image, stock.adobe.com
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