Anti-Obesity Medications – Which Is Right for Me? 

Remember that anything that helps you lose weight likely needs to be continued long-term to keep weight off. The use of medications is as long as they are safe, not causing adverse effects, and working to help you lose weight or maintain the weight lost from the medication, they should be continued long-term; otherwise, you are likely to regain weight.

Metformin

  • Helps metabolic issues, decreases insulin resistance, and can help “level the playing field”
  • Appears to decrease appetite in a few different ways.
  • Reduces chance of diabetes progression
  • Can reduce the risk of some cancers (including colon, lung, ovary, breast, and prostate).

 

Possible side Effects:

 

  • The most common is stomach upset/diarrhea, often mitigated by starting with a lower dose and increasing slowly. There’s an extended-release formulation that is often better tolerated.
  • Need to take 1000 mcg of B12 daily when starting this

Phentermine

  • Suppresses appetite,
  • taken once in the morning (a shorter-acting version is an option)
  • It’s the most prescribed weight loss medication.
  • Affordable, even if not covered by insurance
  • It is a stimulant and controlled substance requiring appointments for refills. If lost or stolen, it cannot be replaced. FDA approval from 1959 was for 3 months of use. Now, the FDA has approved it in lower doses and combinations for long-term use. Specialty organizations with expertise in these medications recommend long term use as stopping the medication leads to weight regain and there is no evidence of harm staying on the medication long term.

 

Possible side Effects:

 

  • Possible nervousness (those who tolerate caffeine usually do well),
  • increased blood pressure,
  • dry mouth, constipation.

Phentermine/Topiramate ER combination (Qsymia)

  • Appetite suppressant combination.
  • Combination is more costly, but able to take generics separately
  • Studies have shown it is one of the more effective medications for weight loss.
  • In some people it can reduce soda cravings by making carbonation taste flat
  • Can help more with evening hunger symptoms

 

Possible side effects

 

  • feeling tired or dizzy,
  • numbness or tingling (most often in the hands),
  • nervousness, dry mouth and constipation
  • Increased blood pressure
  • Serious but less common side effects:
  • Birth defects (women should not get pregnant while taking this medication),
  • glaucoma, kidney stones.

Naltrexone/Bupropion combination (Contrave)

  • Works best on cravings and thoughts about food.
  • Naltrexone can be used for alcohol or opioid addiction, and Bupropion is an antidepressant and smoking cessation aid.
  • Not recommended for those with seizure history or risk of seizure, or for those who are taking opioids

 

Common side effects:

 

  • Nausea (which can get better with time),
  • dizziness, headache,
  • possible increases in blood pressure.
  • Serious but less commonn side effects:
  • Seizure ,mood changes

GLP-1 Agonists: Wegovy (Semaglutide/Ozempic), Zepbound (Tirzepatide/Mounjaro), Saxenda (Liraglutide/Victoza)

  • One of the most effective medication classes for weight loss.
  • Marketed under different brand names for diabetes but insurance coverage and dosing sometimes different (e.g. Ozempic, Mounjaro and Victoza)
  • Slows stomach emptying and decrease hunger hormone to increase feeling of fullness
  • Weekly injection (except Saxenda which is daily).
  • Coverage depending on individual insurance
  • Manufacturing drug shortages may affect access
  • Cannot be taken with a family history of thyroid cancer or history of pancreatitis.

 

Common side effects:

 

  • abdominal pain,
  • nausea, vomiting, diarrhea, constipation, heartburn, and flatulence.