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Saturday, 31 May 2014

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Eating less and moving more are the basics of weight loss that lasts. For some people, prescription weight loss drugs may help.

You'll still need to focus on diet and exercise while taking these drugs, and they're not for everyone.

Doctors usually prescribe them only if your BMI is 30 or higher, or if it's at least 27 and you have a condition that may be related to your weight, like type 2 diabetes or high blood pressure.

Here's what you should know about four of the most common prescription weight loss drugs: orlistat, Belviq, phentermine, and Qsymia.

Before you get a weight loss drug prescription, tell your doctor about your medical history. That includes any allergies or other conditions you have; medicines or supplements you take (even if they're herbal or natural); and whether you're pregnant, breastfeeding, or planning to get pregnant soon.

Orlistat

How it works: Blocks your body from absorbing about a third of the fat you eat.

When a doctor prescribes orlistat, it's called Xenical. If you get it without a prescription, it's called Alli, which has half of Xenical's dose.

Approved for long-term use? Yes.

Side effects include abdominal cramping, passing gas, leaking oily stool, having more bowel movements, and not being able to control bowel movements.

These side effects are generally mild and temporary. But they may get worse if you eat high-fat foods.

Rare cases of severe liver injury have been reported in people taking orlistat, but it's not certain that the drug caused those problems.

What else you should know: You should be on a low-fat diet (less than 30% of your daily calories from fat) before taking orlistat.

Also, take a multivitamin at least 2 hours before or after taking orlistat, because the drug temporarily makes it harder for your body to absorb vitamins A, D, E, and K.

Orlistat is the only drug of its kind that's approved in the U.S. All other prescription weight loss drugs curb your appetite, including the following.

Belviq

How it works: Curbs your appetite.

Approved for long-term use? Yes.

Side effects: The most common side effects in people who don't have diabetes are headache, dizziness, nausea, fatigue, dry mouth, and constipation.

The most common side effects in those who have diabetes are low blood sugar (hypoglycemia), headache, back pain, cough, and fatigue.

People taking some depression medications with Belviq need to be monitored very closely for a rare but serious reaction that includes fever and confusion.

Women who are pregnant or planning to get pregnant shouldn't take Belviq.

What else you should know: If you don't lose 5% of your weight after 12 weeks of taking Belviq, you should stop taking it, because it's unlikely to work for you, the FDA says.

Many people, including doctors, have a strong aversion to using weight loss drugs to treat obesity, according to Holly Wyatt, MD, an endocrinologist at the University of Colorado Health Sciences Center. The longstanding wisdom was that obesity resulted from a failure of willpower. If only people would just stop eating so much and get off the couch, no one would be obese. So why bother with drugs?

But that simple way of thinking is increasingly under fire from experts. It isn't the whole story.

"Lifestyle is a big factor in why people gain weight," Wyatt tells WebMD. "But there's a definitely a genetic and a physiologic reason, too. Because of differences in physiology, some people will just have a harder time losing and maintaining weight than others."

George A. Bray, MD, professor of medicine at Louisiana State University, agrees that the traditional view of obesity -- as essentially a moral failing -- is wrong.

"Are people who are massively overweight because they lack [the hormone] leptin 'weak-willed'?" asks Bray. "No, and, in fact, some kind of neurochemical derangement probably underlies most obesity."

"It's cruel and hurtful to categorize overweight and obese Americans as 'lazy' or 'weak-willed,'" he says, "and to conclude that all they need to do is just push themselves away from the table."

Obesity as a Disease

Obesity is a killer. So is it enough for a doctor to tell a chronically obese person to lose weight and leave it at that? Wyatt and Bray both point out that we routinely use medication for other conditions that can be controlled by changes in diet and exercise.

For instance, diabetes and high blood pressure can both be helped substantially by changes in your lifestyle. But doctors still prescribe medication for both conditions. It would be highly unlikely for your doctor to refuse to give you diabetes medicine simply because you could control the disease with more exercise and a stricter diet but don't. Everyone knows that permanent lifestyle changes are very hard to make, Wyatt says.

"We don't punish diabetics or people with high blood pressure by withholding medicine," says Wyatt. "So why should we punish people with obesity? If you have a medication that will make it easier for people to lose weight, why not use it?"

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2 comments:

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