Want to jump-start the pound parade?
You don’t have to go weight loss alone.
Mary Dagen, MD, ABOM, an obesity medicine specialist who runs the weight management clinic in the Spectrum Health Medical Group Grand Haven office, said medicine can be an effective tool for overweight patients, when coupled with smart lifestyles choices and changes.
Dr. Dagen said some people become motivated to make lifestyle changes once the scale starts its downward march. That’s where weight-loss meds can help.
“There are people that need to see change to make a change,” Dr. Dagen said.
But taking weight-loss medications isn’t a cure-all.
“This is a tool in the toolbox, but if they’re not doing their work, it’s not going to work,” Dr. Dagen said. “People can eat through these medications. They have to be making bigger changes.”
Dr. Dagen meets with her patients individually, figuring out what weight-loss strategy makes sense.
“What works for one person doesn’t work for the next,” she said. “About 80 percent of initial weight loss is based on food changes. Exercise is important for weight maintenance, but you’re not going to lose a huge amount without food changes.”
Other tips? Drink more water, eat more fruits and vegetables, don’t skip meals and stay away from restaurants.
Weight-loss medications can be helpful for patients who hit a plateau with their own efforts.
“All patients will do that at some point,” Dr. Dagen said. “It doesn’t need to be an end-point. Medications can jump-start things.”
Different medications target different means of weight loss, some suppressing appetite while others can produce unpleasant results if you’re ingesting too much fat.
Side effects vary widely, too.
Here are some of the more popular choices on the market:
This was a pioneer in weight-loss medications, and is the oldest medicine on the market.
“It’s an appetite suppressant,” Dr. Dagen said. “It’s a stimulant and it works very quickly in the sense of usually people can feel it working. They feel like they have a lot more energy and they don’t feel as hungry. The problem is, the longer they take it, this feeling wears off. People tend to get frustrated with that.”
Dr. Dagen said the goal becomes to take advantage of the first three weeks when the drug is most effective.
Ideally, the patient will get used to eating less while on the medication, and continue to do so once they no longer feel the initial effects of the medicine.
Phentermine can only be taken once a day. When consumed in the morning, the effects may wear off by dinner time, when people tend to eat and snack more.
“This medication is great for people struggling with overeating or eating mindlessly,” Dr. Dagen said.
The newest drug on the market can be taken up to three times a day. This is a shorter-acting form of phentermine, so it allows for more flexibility than the once daily medication.
“This medication is good for people who do great for breakfast and lunch, but then they get home and eat everything in sight,” Dr. Dagen said. “You can take it with dinner and it will give you some coverage with bedtime snacking. But if you take it too late, you’re not going to sleep well because it’s a stimulant.”
It can cause heart palpitations, anxiety and high blood pressure.
“I personally don’t see that very often, but you have to be careful with patients who already have hypertension,” Dr. Dagen said.
This appetite-suppressing medication hit the market several years ago.
“We know it causes significant weight loss for a lot of people,” Dr. Dagen said. “The long-term studies are out and it’s a pretty solid medicine.”
Women who could potentially become pregnant should not use this medicine.
This medication targets the portion of the brain responsible for addiction and is beneficial for people who are overeaters or have food addictions.
“It can help combat some of those cravings the mind has to help people not overeat and to not rush to the bakery when they could be eating fruits and vegetables,” Dr. Dagen said.
People who are on mood disorder or pain medications should not take Contrave because of potential interactions.
“It will actually make those medications stop working,” she said. “Medications for mood disorders are the most commonly prescribed medications in the country. Most people who are struggling with weight are struggling with a mood disorder.”
This medication also targets food addiction and cravings.
“It works on various selective serotonin receptors in the brain,” Dr. Dagen said. “You have to be very cautious if people are on other medications for mood disorders. Most of the people I see are on those medications.”
“I love this medication,” Dr. Dagen said. “It’s a once-a-day injection.”
Originally released under a different name for diabetes treatment, Saxenda affects the portion of the brain that controls how full we feel.
“It works well so people are able to eat less,” she said. “It’s not a stimulant and it’s long-lasting.”
The biggest side effect is nausea, but you will only feel sick if you overeat.
“It keeps people honest about what they’re eating,” Dr. Dagen said. “I like the concept of it. You can use it on anybody. It’s one of my top choices.”
The only over-the-counter medication to make the list, Alli works in the body to fight fat absorption.
“It has very few side effects, but you have to eat less than 30 percent fat in your daily intake or the medicine will kick that right back out of your system and you’ll have some pretty significant gastrointestinal issues. I always tell people if they’re going to use it, they really have to be careful counting fat and calculating fat. That’s really hard for people.
A pharmacist’s perspective
Ryan Foster, head of pharmacy at Spectrum Health, said weight-loss medications are generally safe when taken as prescribed.
“Drug therapy should only be started after a comprehensive discussion with your provider—including discussion of the risks and benefits and setting realistic goals,” Foster said “These drugs serve a very specific purpose in weight-loss therapy, but I need to emphasize that none of them are the ‘magical’ pill that will lose weight for you.”
Foster said there are many medications to choose from.
“This is important because we can now better target specific areas contributing to weight gain,” he said. “Phentermine, which is the oldest medication in our inventory, tends to have a few more side effects than the newer medications.”
Lifestyle change still remains the best hope for people aiming to drop weight.
“These medications, when used in conjunction with lifestyle changes such as diet and exercise, can be effective in helping patients lose weight,” Foster said. “These medications will not lose weight for you nor do they cure obesity. Many of these drugs reach a maximum effect over time and weight loss will eventually stop, which is why it is critically important to make sustainable lifestyle changes.”