EVMS physician discusses benefits of obesity drugs
Even as members of the medical community learn to view and treat obesity as a chronic disease, it is still a topic which patients can be hesitant or even embarrassed to discuss. According to the Centers for Disease Control, obesity affects approximately 41.9% of adults and causes conditions including arthritis, heart disease, stroke, Type 2 diabetes and certain types of cancer.
Though bariatric surgery is a proven tool for weight loss in many patients, like any surgery it comes with risks and can cause permanent irreversible changes in lifestyle. This may lead some to seek alternatives, including medication, for help with losing weight.
“The best candidate for weight loss medication is a motivated young person who has not yet developed any problems from their obesity,” says Kelly Latimer, MD, Associate Professor of EVMS Family and Community Medicine, “but older people who have developed obesity-related problems will also benefit from weight loss.”
These weight-loss drugs have been approved by the U.S. Food and Drug Administration (FDA) for long-term use:
- Bupropion-naltrexone (Contrave)
- Semaglutide (Ozempic, Wegovy) and Liraglutide (Saxenda)
- Orlistat (Xenical, Alli)
- Phentermine-topiramate (Qsymia)
Semaglutide, known by the brand name Ozempic, has also been recommended for teenagers, and Dr. Latimer agrees that if teens are motivated then it is the perfect time for them to lose weight.
Other medications in the same class as liraglutide and semaglutide also cause weight loss and may be prescribed for that reason but are not on the FDA list because they have not been specifically studied for the indication. These include the Medicaid-preferred dulaglutide (Trulicity) and exenatide. If an expensive medication is cost-prohibitive, Dr. Latimer says she will prescribe one that is covered by the patient’s insurance.
There are side effects with each medication of which patients should be aware and discuss with their healthcare provider. Semaglutide requires a self-administered weekly shot and can cause stomach upset, phentermine is a controlled substance and can cause a racing heartbeat and high blood pressure and topiramate is an effective preventative for migraines which has the side effect of losing weight. Orlistat can be obtained over the counter and may cause bloating and oily stools.
Results may not come quickly. “The STEP (Semaglutide Treatment Effect in People with Obesity) trial showed an average of 12% weight loss by 28 weeks,” Dr. Latimer explains, “you didn’t gain the weight overnight and you aren’t going to lose the weight overnight.
Patients can set themselves up for success during treatment by regularly seeing a dietician, joining a support group and finding an exercise buddy. Healthy lifestyle membership programs may also provide motivation to stick with it.
Dr. Latimer urges anyone who is interested in the medications not to delay speaking to their healthcare provider. “You would not feel embarrassed if you had asthma. You shouldn’t feel embarrassed about obesity, especially if you have decided to seek help. Good on you! Your doctor wants to help you be healthy. Most doctors I know are so excited to help patients treat their chronic disease of obesity.”
To learn more about weight loss medications or to make an appointment with Dr. Latimer, contact EVMS Family and Community Medicine.