The Truth About Weight Loss Medications: A Tool, Not A Cheat

This week, I’d like to discuss a somewhat controversial topic: weight loss medications. 

Don’t get me wrong. I don’t think there is anything controversial about taking weight loss medications.

When you understand the biology of weight gain and weight loss, you know that weight loss medications are an invaluable tool for a lot of people.

Unfortunately, there are a lot of people out there that still see using weight loss medications as “cheating”.

Well, I’m here to convince those people (and maybe you) that weight loss medications are no different than using medications to treat high blood pressure or diabetes. Sometimes they are essential. 

Understanding Weight Regulation

The most important thing to understand is that weight regulation is a complex, multifaceted issue that cannot be solely attributed to a lack of willpower or discipline.

This is the main problem I see in our current societal beliefs about people who have overweight or obesity… that somehow it is their fault and if they were just more disciplined, they would not have weight problems. I even see a lot of patients that believe this about themselves.

The truth is that a person's weight as very little to do with their willpower or discipline.

We must acknowledge that there are many factors that play a role in determining someone’s weight, including genetics, hormones, and lifestyle. Because of this complexity, no one-size-fits-all solution exists for weight loss.

For a lucky few, lifestyle changes such as adopting a healthy diet and engaging in regular exercise may be enough to achieve their weight loss goals. For others, however, these interventions will not be enough to reach their desired results. That’s why it is so important to remember that each person's journey is unique, and there is absolutely no shame in seeking additional help.

Weight Loss Medications: A Helpful Tool

If you are one of the millions of people in our country that have had limited success (or none at all) with using diet and exercise to lose weight, weight loss medications may be something you want to consider. These medications work by suppressing appetite, increasing feelings of fullness, or altering the body's metabolism to burn more calories. 

Let’s talk about some of the most commonly prescribed weight loss medication: 

Phentermine:

This is an oldie but a goody. It has been around for decades and can work very well. I especially like it for people who eat very little, but still can’t lose weight, as it boosts the metabolism a bit. In the past, this medication was only allowed to be prescribed for 3 months at a time, but we know now that it is safe to stay on long term. In fact, some people choose to stay on it indefinitely in order to maintain their weight loss. Another benefit to this medication is that it is very inexpensive… typically less than $20 per month. 

Qsymia:

Qsymia is a combination of phentermine and a medication called topiramate. Topiramate is commonly prescribed for migraines and is an anti-seizure medication. These two medications work really well together to reduce appetite and increase feelings of fullness. I’ve seen really great results using this medication, although it can be significantly more expensive unless your insurance covers it. It runs about $200 per month. BUT we can prescribe phentermine and topiramate separately for the same effect, and it is MUCH cheaper… Usually between $20 and $30 per month. 

Contrave:

This medication is another combination drug. It combines Wellbutrin (a common antidepressant that increases dopamine) with naltrexone (a medication typically used to block opioids). The way this works is pretty brilliant. Wellbutrin increases the amount of dopamine produced in your brain and naltrexone makes sure that it stays around long enough to work, effectively further increasing the amount of dopamine in the brain. The result is a significant decrease in appetite. It is important to note that Contrave is not recommended for individuals with a history of seizures or eating disorders. As for cost, this one can be expensive without insurance coverage ($500 per month!!!), but we can use the same trick as we use for Qsymia… prescribing the 2 medications separately. This will cost you between $10 and $20 per month at most pharmacies. 

Semaglutide:

Also known as Wegovy or Ozempic, semaglutide is a once a week injection that mimics a hormone in our body called GLP-1. GLP-1 is one of the many hormones that are released by our digestive tract after we eat to tell our brain that we have had enough and we are full. As a result, semaglutide causes an increased feeling of fullness and decreased hunger. In addition to this, GLP-1 increases the body's sensitivity to insulin and helps regulate blood sugar (which is why it is commonly used to treat diabetes). This medication is hugely popular right now because we can see very significant weight loss with it, even when nothing else has helped before. The problem is that it is VERY expensive and unless you have diabetes, many insurance companies do not cover it. And even when they do, deductibles and copays can still make it unaffordable for many. Without insurance, it is around $1400 per month! There is a coupon that can help, but it is still expensive no matter how  you look at it. 

As a quick aside, there are compounded options for semaglutide that are much cheaper, but I’m going to save that discussion for another blog because it is a very complicated topic. 

Tirzepatide:

Also, known as Mounjaro, this medication has not officially been approved for weight loss yet. It is currently only officially approved for the treatment of diabetes… However, we are expecting FDA approval as early as this month! Some of you may know people (or be people) that were lucky enough to qualify for the coupon when it first came out. This allowed you to get it for practically no money regardless of your diagnosis. Unfortunately, they no longer will allow the coupon to be used unless you have a diagnosis of diabetes. Sometimes we can get it approved if you have something called “metabolic syndrome”, but that is a rare circumstance. If you are one of the lucky ones that got the original coupon, your coupon may still work… or it may not. There seems to be no rhyme or reason to whose will still work and whose will not. If you are looking to pay cash, this one will cost you around $1100 per month. There are also compounded options, but again, it’s a complicated discussion that I will leave for another day.

Vyvanse:

Lastly, we will briefly discuss Vyvanse, traditionally used to treat ADHD. This medication is approved for use in adults with moderate to severe binge eating disorder. It functions by increasing dopamine levels in the brain, reducing the urge to binge eat. Interestly, it works really well to reduce binging, but really does not affect weight that much. 

The Importance of Working with a Provider with Special Training in Obesity Medicine

As a board certified obesity medicine physician, I would be remiss not to emphasize how important it is to work with someone that has the proper training to not just prescribe these medications, but to manage them. There is so much more that goes into a great weight loss program than just writing a prescription for medication every month. It is both an art and a science that requires an in-depth understanding of the biology and physiology of weight loss. 

The Role of Weight Loss Medications in a Comprehensive Plan

Finally, I want to emphasize that while weight loss medications can be a valuable addition to a comprehensive weight loss plan, they should be just that… an addition. Your doctor should screen you for any underlying problems that may be keeping you from losing weight. And you still need to eat a balanced diet, exercise regularly, get the proper amount of sleep, etc. All of these things work together to get you the best results, not just for your weight, but for your overall health. 

As always, let me know if you have any questions or if I can help you in any way!