Our Approach To Anti-Obesity Medications
Anti-obesity medications, also known as weight loss drugs, are prescription medications used to help individuals with obesity or overweight conditions lose weight and maintain that weight loss. These medications work through various mechanisms, including suppressing appetite, increasing satiety, or interfering with fat absorption.
Anti-Obesity Medications may complement a lifestyle approach for those who qualify. Eligibility includes a BMI over 27 with comorbidities like high blood pressure, diabetes, or hypertension, or a BMI over 30 with or without comorbidities.
Types of Anti-Obesity Medications:
- Appetite Suppressants:
These medications, like phentermine, work by stimulating the central nervous system to decrease appetite and increase heart rate.
- Fat Absorption Inhibitors:
Orlistat, for example, blocks the absorption of dietary fat in the intestines.
- Combination Therapies:
Some medications combine different mechanisms. For instance, naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect appetite and cravings.
We Do Not Sell, We Prescribe
Prescribing anti-obesity meds involves assessing a patient's individual needs and health status before recommending and adjusting medications, ensuring safety and effectiveness, and counseling on continued use. Unlike many clinics that buy and mark up obesity medications, we prescribe through insurance if obesity treatment is covered. We offer self pay options as well. We can order less expensive compounded drugs for patients who qualify. We don't buy and resell compounded drugs at marked up prices. For any compounded drugs not covered by your insurance, you pay the pharmacy directly. We do not profit from your decision to take anti-obesity medications.
Length of Treatment
The duration of anti-obesity medication treatment vares but is generally considered a long-term approach due to the chronic nature of obesity. While some medications are approved for short-term use (e.g., 12 weeks for phentermine), others are intended for longer-term management. The decision to continue or discontinue a medication is often based on individual response, including weight loss achieved and side effects.
Factors influencing treatment duration:
- Type of medication:Some medications, like phentermine, are typically prescribed for short-term use (e.g., 12 weeks). Others, like liraglutide or semaglutide, may be used long-term as part of a comprehensive weight management plan.
- Individual response:Clinicians often assess weight loss progress after a set period (e.g., 12 weeks) to determine if the medication is effective. If a significant amount of weight loss is not achieved (e.g., 5% or more), the medication may be discontinued.
- Overall health goals:Anti-obesity medications are often used to improve health outcomes related to obesity. If a patient achieves significant weight loss and improves health markers, the medication may be continued long-term.
- Risk of weight regain:Because obesity is a chronic condition, discontinuing anti-obesity medication can lead to weight regain. Therefore, long-term treatment may be necessary for some individuals.
Semaglutide
Semaglutide is a medication that belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. It mimics the natural hormone GLP-1, which is released in the gut after eating.
Here's how semaglutide works:
- It stimulates insulin production in the pancreas in response to high blood sugar levels.
- It slows gastric emptying, which helps people feel full longer and reduces appetite.
- It reduces glucagon release, which lowers the amount of sugar the liver produces.
- It interacts with the parts of the brain that suppress appetite and signal you to feel full, helping with weight loss.
Semaglutide is FDA approved for several uses, depending on the specific brand:
- Type 2 Diabetes Management: Used as an adjunct to diet and exercise to improve blood sugar control in adults with type 2 diabetes.
- Cardiovascular Event Reduction: Approved to reduce the risk of major adverse cardiovascular events (like heart attack or stroke) in adults with type 2 diabetes and established cardiovascular disease. It's also approved to reduce the risk of cardiovascular events in adults with obesity or overweight and cardiovascular disease.
- Chronic Weight Management: Approved for weight loss and weight management in adults with obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 27 kg/m2) with at least one weight-related condition, such as high blood pressure or type 2 diabetes.
- Chronic Kidney Disease: It is also used to lower the risk of worsening kidney disease, kidney failure (end-stage kidney disease), and death caused by heart or blood vessel disease in patients with type 2 diabetes and chronic kidney disease.
Tirzapetide
Tirzepatide is a medication that is approved for use in adults with type 2 diabetes mellitus, chronic weight management, and obstructive sleep apnea.
Tirzepatide is a novel dual agonist that acts on both the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. By mimicking the effects of these naturally occurring hormones, tirzepatide works by:
- Stimulating insulin release: It encourages the pancreas to release more insulin after meals, helping to lower blood sugar levels.
- Reducing glucagon secretion: It decreases the amount of glucagon, a hormone that raises blood sugar, produced by the liver.
- Slowing gastric emptying: It slows the rate at which food leaves the stomach, which can contribute to feelings of fullness and reduce appetite, potentially aiding in weight loss.
- Influencing appetite regulation: It interacts with areas in the brain that regulate appetite and food cravings.
Tirzepatide is FDA-approved for adults with type 2 diabetes mellitus (as an adjunct to diet and exercise), chronic weight management in adults with obesity or overweight (with at least one weight-related comorbidity), and moderate to severe obstructive sleep apnea in obese adults (as an adjunct to diet and exercise).
Phentermine
Phentermine is a prescription medication primarily used for the short-term treatment of obesity. It is intended for individuals who are overweight or obese and haven't achieved significant weight loss through diet and exercise alone.
How it works:
- Appetite Suppressant: Phentermine is classified as an anorectic, meaning it works by decreasing appetite.
- Central Nervous System Stimulant: It acts as a stimulant on the central nervous system, affecting brain signals that control hunger. This mechanism is similar to that of amphetamines.
- Potential increase in energy expenditure: While not its primary action, its stimulant properties may indirectly contribute to increased physical activity levels.
Usage:
- Short-term use: Phentermine is typically prescribed for a limited duration, often 3 to 6 weeks, or up to 12 weeks, as your body can develop tolerance to its effects.
- Part of a comprehensive plan: It is meant to be used in conjunction with a reduced-calorie diet, exercise, and behavioral modifications.
Phentermine-Topiramate
Phentermine-topiramate, sold as the extended-release capsule Qsymia, combines two drugs: phentermine and topiramate. It's used for chronic weight management in adults with a BMI of 27 kg/m² or higher and a weight-related comorbidity (like hypertension, type 2 diabetes, or dyslipidemia), or those with a BMI of 30 kg/m² or greater, in addition to diet and exercise. It is also approved for pediatric patients 12 and older with a BMI at or above the 95th percentile for their age and sex.
Mechanism of action:
- Phentermine: Reduces appetite by increasing norepinephrine levels in the central nervous system.
- Topiramate: Believed to suppress appetite and enhance satiety through various mechanisms, including effects on GABA receptors and ion channels.
Bupropion-Naltrexone
Bupropion-naltrexone, known as Contrave®, is a combination medication for chronic weight management in adults when combined with a reduced-calorie diet and increased physical activity. It's prescribed for adults with obesity (BMI ≥ 30 kg/m²) or those who are overweight (BMI ≥ 27 kg/m²) with at least one weight-related medical issue, such as type 2 diabetes, high cholesterol, or high blood pressure.
This medication influences brain areas involved in appetite and reward systems: the hypothalamus and the mesolimbic dopamine circuit:
- Bupropion: An antidepressant that affects dopamine and norepinephrine levels and stimulates POMC neurons in the hypothalamus to decrease appetite and increase energy expenditure.
- Naltrexone: An opioid antagonist that blocks opioid receptors, amplifying bupropion's effect on POMC neurons to enhance appetite reduction and craving control.
