Do Prescription Medications Work for Weight Loss?
I remember way back in the day (okay, about 4-5 years ago) when I first started practicing, I thought that helping people lose weight was going to be easy.
All I needed to do was write a prescription for a couple of weight loss medications, have the patients take them, and BOOM weight loss.
Well... it didn't quite turn out that way, but I learned a LOT in the process.
While I don't practice anymore, I still have had the advantage of using prescription medications for many years on MANY patients.
And through this experience, I've learned quite a lot including which medications work best, how to use them effectively, when they should be used, and much more.
Today I want to talk about just that:
Prescription medications that can help YOU lose weight.
This article is for you IF...
You've tried losing weight the old-fashioned way through diet and exercise without much success.
If you find that weight loss is incredibly difficult no matter how hard you try.
If you've tried and failed multiple diets in the past and feel like nothing works for you.
Or if you just want to find a way to lose weight faster.
Prescription weight loss medications can be incredibly effective but if the right ones are used and only if they are used correctly.
These medications can help in the following ways:
- Help accelerate your efforts (you lose weight faster)
- Break through weight loss plateaus
- Augment existing therapies such as diet and exercise
- Help to balance hormones
- Help manage your appetite and food cravings
Sounds good, right?
Well, hold on, because even though these medications can be VERY effective they should never be used by themselves.
This is the part where I tell you that diet and exercise is still very important when looking at any prescription medication.
I know your eyes are glazing over but this is really important.
If you really want to have long lasting weight loss then you need to combine these medications with diet (eating a whole food based diet), regular exercise, and intermittent or prolonged fasting.
This will get you the BEST results possible for your body.
And lastly, before we jump in, make sure that you touch base with your doctor before using any of these medications.
These medications are powerful and can have a serious impact on the body.
With this in mind, let's jump in...
The Best & Most Effective Prescription Weight Loss Medications
Believe it or not, there are many different types of weight loss medications on the market (1) and they all work a little bit differently.
Some weight loss medications help to boost your metabolism, others help manage your appetite, and others balance your hormones.
Every single aspect is important for long lasting weight loss, which is why it may be important to stack these medications on top of each other.
You should also be aware that many of these medications are considered "off-label" when used for weight loss.
Medications get this distinction if they are not FDA approved for a specific condition, even though they work well for that condition.
I'll let you know when a medication is FDA approved or not if that sort of thing is important to you.
It may also further surprise you to know that insurance RARELY covers them.
Doesn't make any sense, right?
I know but this is where we are at right now.
Even though losing weight virtually guarantees better health outcomes (2), reduced inflammation in the body, a decreased risk of diabetes, heart disease, stroke, and so on, they still won't be covered.
In addition, it's unlikely that your doctor is aware of these medications or how effective they are.
Again, it may be surprising, but it shouldn't be.
Our current healthcare system is focused more on management and not prevention.
And what is weight loss if not prevention?
Losing weight improves mental health, physical health, and your overall well being.
But these are not important in a management based system.
It's frustrating but it is what it is.
#1. Saxenda or Victoza
First on the list are probably the most effective out of all of the medications we are going to talk about.
While they are very effective they also come with a long list of potential side effects.
As someone who is trying to lose weight, you always need to weigh the pros and cons of each medication before actually using them.
In many cases, it's probably preferable to accept some risk of side effects if the potential outcome is 40-50 pounds or more of weight loss.
This may not be true for you but it's something to consider.
In terms of FDA approval, Saxenda is FDA approved for weight loss (3) while Victoza is not.
But don't let that worry you because both medications are virtually identical.
They both use the same underlying medication (known as liraglutide) and these medications differ only in their maximum dose.
Saxenda can be titrated up to 3.0mg per day while Victoza has a smaller maximum dose.
The story behind Victoza is very interesting.
Victoza was FDA approved to treat type II diabetes but it was found that when patients used this medication they lost a ton of weight (4).
The pharmaceutical company that manufactured Victoza then decided to create a separate medication and get that medication FDA approved for weight loss.
The result was Saxenda.
This is both good and bad.
Good because it means that it's easier to get your doctor to prescribe it and bad because it means that it isn't covered by insurance.
The good news is that you can sometimes get Victoza covered but only if you can confirm a diagnosis of insulin resistance or diabetes.
Both of these medications work by impacting the GLP-1 receptor and are known as GLP-1 agonists.
The result of impacting this receptor is a decrease in your appetite and a corresponding change to several important hormones including insulin and leptin.
Many people who start taking Saxenda or Victoza notice a dramatic decline in their appetite.
Normally this would be a problem (we will talk more about this when we get to Phentermine) as it tends to cause a RISE in leptin.
Fortunately, both medications blunt the normal rise in leptin that would occur and prevent leptin resistance from occurring due to appetite suppression.
There are many other types of medications that fall into the class of GLP-1 agonists and they can all work.
The key to finding which one works for you will require some trial and error as well as working with your insurance company to see if you can get them covered.
The cash price for Saxenda is very high at around $1,300 per month.
So it's best to try and get insurance to cover one of the other medications if possible!
#2. Invokana or Farxiga
Next on the list do not come in order of effectiveness!
Even though these are number 2 on the list doesn't mean they are the second most effective.
From here on out, the effectiveness of each medication is highly variable and depends on the individual.
Both of these medications are NOT FDA approved for weight loss and yet they have been shown to cause weight loss (5).
They work by blocking a special receptor in the kidney which absorbs glucose in the blood.
Normally, your kidneys are VERY good at absorbing sugar back into the body because it's a valuable resource used to create energy.
By taking an SGLT-2 inhibitor like Invokana, your kidneys can not absorb that sugar back into the body and you instead pee it out.
This results in lower blood sugar levels and a reduction in insulin levels.
What you will find is that most medications that truly reverse insulin resistance also tend to result in weight loss because insulin resistance causes weight gain and weight loss resistance.
There are many types of SGLT-2 inhibitors on the market so it's often best to start with whichever version your insurance will cover.
Like Victoza, these medications can be somewhat difficult to get because they are primarily used to treat type II diabetes.
They can obviously be effective for people who don't have type II diabetes but it is harder for these people to get them.
You can pay cash for them at any time if your insurance won't cover them, but right now the average monthly cash price is around $500 per month.
You do NOT want to use these medications if you have no issues with insulin resistance, though!
And you should be aware that peeing out extra sugar/glucose can come with problems such as increasing your risk of developing urinary tract infections.
Naltrexone is probably one of the least well known of all medications on this list.
Originally designed to treat alcohol dependence (6), it has shown additional benefits as it relates to weight loss.
No one really knows exactly how it helps with weight loss but there are a few theories.
My personal opinion is that it is helping to reduce something called the body set point (7) which is a sort of thermostat which your brain uses to set your weight.
When your weight is "set" at a certain point it can be difficult to lose any weight as your body will do whatever is necessary to keep you at that weight.
The idea is that taking Naltrexone can help reset that body set point and help your brain to recognize your new lower weight as the new "set point".
That way you can actually keep the weight off that you've lost!
We also know that Naltrexone can help balance hormones such as insulin.
Naltrexone itself isn't FDA approved for weight loss but it is found in a combination weight loss medication which is FDA approved.
That medication is known as Contrave and it contains a combination of naltrexone and bupropion.
If you are having trouble getting your doctor to prescribe naltrexone by itself then you might have better luck getting him or her to prescribe Contrave due to its FDA approval.
One thing is for sure, though:
Researchers and pharmaceutical companies wouldn't spend millions of dollars to advertise a medication that doesn't work and I've had a lot of success using naltrexone by itself for purposes of weight loss.
You may also find naltrexone referred to as different names including LDN or low dose naltrexone.
The reason this is important is because the FDA approved dose for alcohol dependence is MUCH higher than is required for weight loss.
Doses of naltrexone in Contrave vary but start at 8mg.
I've personally found a lot of success with Naltrexone in doses ranging from 4.5mg to 13.5mg.
The alcohol dependence dose is somewhere around 50mg which is significantly higher than what we are talking about here.
Another big benefit to using naltrexone is that it is very well tolerated and has very few side effects!
The downside is that it's not quite as effective as the other medications we've discussed.
But this trade off of efficacy for side effects is very helpful to you as someone who is trying to lose weight.
It means you can add naltrexone to other medications or start with it if you want to be as conservative as possible.
Metformin is an oldie but a goodie.
It's one of those medications that many of you have probably already tried if you are listening to it.
If not, then it may be one of the first medications you want to try before using the others I've discussed here.
Because it's incredibly cheap, pretty well tolerated, and has a huge range of benefits.
Metformin is considered first line therapy for pre-diabetes, insulin resistance, and even in many cases of type II diabetes.
It is most noted for its effects on helping to reduce blood sugar and insulin resistance but it also has an impact on many other systems in the body.
It's frequently used by anti-aging doctors to help with the aging process and is also used for weight loss purposes as well.
The biggest downside to metformin is that it's not quite as effective as the other medications.
Metformin can definitely work but I think it shines best when used in very specific situations.
As an example, metformin can be used in addition to the other weight loss medications we've discussed when you hit a weight loss plateau.
Metformin appears to have a synergistic effect on other medications, especially those that target insulin resistance.
If you are looking to dip your toes into the water of weight loss medications then metformin may be the best place to start.
Most doctors have no problem prescribing it even if it means using it off-label for weight loss.
In addition, even if your insurance doesn't cover it, you shouldn't pay more than 10 bucks per month.
Metformin is NOT FDA approved for weight loss.
Last on the list is Phentermine.
Phentermine is well known by conventional doctors and may be one of the most commonly prescribed weight loss medications on this list.
It is FDA approved for weight loss (8) when combined with diet and exercise.
Even though Phentermine CAN be an effective weight loss medication, in order for it to assist with long lasting results, it must be used correctly.
If you use it the standard way your doctor prescribes then you may lose weight but this weight loss will be temporary and short lived.
Phentermine works by doing 2 things:
The first is suppressing your appetite and the second is boosting your metabolism.
It falls within the family of stimulants and these medications tend to have an effect both on metabolism and appetite suppression.
Sounds good, right?
Well, yes and no.
Appetite suppression is not always good and, in fact, can be the enemy of thyroid patients.
If thyroid patients suppress their appetite too much then they may cause more thyroid damage and cause damage to their metabolism.
Appetite suppression may cause weight loss, that's true, but what happens once you stop taking the medication?
The weight comes right back on.
In addition, because phentermine is a stimulant, it can't be taken forever.
Your body may become tolerant to the medication and it may cause side effects such as insomnia and elevated blood pressure.
So why do I recommend phentermine?
I only recommend it in certain scenarios and if used correctly.
My method of using phentermine includes using it only periodically and only when you are also utilizing certain fasting techniques.
By combining phentermine with fasting you enhance the beneficial effects of fasting while reducing the potential for side effects of the medication.
You also don't have to worry about weight gain when you stop using it AND you don't have to worry about tolerance to the medication.
These benefits occur when you use phentermine no more than about twice per week.
As I mentioned previously, if you use phentermine daily you may lose some weight initially but that weight will come back once you stop it.
And each subsequent time you use phentermine you will see a diminished weight loss effect.
So if you decide to use phentermine make sure you use it correctly!
How to Get These Medications From your Doctor
What good is a prescription weight loss medication if you can't actually get your hands on it?
Your doctor may pay lip service to the idea that you need to lose weight but are they actually willing to do something about it?
For whatever reason, doctors really don't like prescribing weight loss medications.
This includes the standard FDA approved weight loss medications like Phentermine and Contrave!
Why they don't like prescribing them is somewhat of a mystery to me but I believe it probably has to do with the fact that they just aren't used to using them very often.
Your doctor has MUCH more familiarity with metformin than they do with Saxenda.
As a result, they will probably have no issue prescribing you metformin off label but not Saxenda even though the latter is FDA approved for weight loss.
So what can you do to get these medications?
Even though your doctor may be hesitant to prescribe them, they are still the best first place to start.
Schedule an appointment with your doctor with the specific purpose of talking about weight loss.
Do NOT tack this conversation on to the end of another appointment or visit!
I've been with many patients who try to do this and it never works.
Come in with a plan and come in with the topic of weight loss in mind.
If your doctor knows what to expect during the appointment he/she will be much more likely to work with you.
The next step is to come prepared to discuss these various medications.
And by prepared, I mean you may need to come with medical studies or information directly from the pharmaceutical website.
Come prepared with printed handouts to give to your doctor!
The easier you make this for them the more likely they are to prescribe the medication for you.
You'll also want to have a basic understanding of the potential side effects that the medication you are looking at may cause, as well as some idea on dosing.
In addition to all of this information, make sure you come to your appointment with a plan for diet and exercise!
If you can show your doctor that you are willing to do more than just take a medication then they will be much more likely to write that prescription.
Lastly, if your doctor isn't willing to work with you at all or even willing to hear out your request then it may be time to seek out a second opinion.
You can find doctors who specialize in weight loss, hormone balancing, and anti-aging medicine who are more familiar with these medications.
The only downside to these doctors is that they usually don't accept insurance so the price of a visit may be more expensive than what you are used to paying.
Don't be afraid to be persistent. The squeaky wheel gets the grease, as they say.
Use These with Your Medications
Way back at the beginning of this article I mentioned that whenever you consider using prescription weight loss medications that you should also combine them with other therapies.
I mentioned diet, exercise, sleep, as well as supplements.
Every single therapy you can add to your weight loss regimen will increase your results.
Supplements are a great way to augment your weight loss regimen and can even enhance the effects of the prescription weight loss medications we've discussed above.
Some of my favorites include:
- Berberine - Berberine is a plant compound that can help build muscle mass, suppress the appetite, and help build lean muscle mass.
- Protein Powder - Protein powder can help with weight loss by reducing food cravings and by helping to build lean muscle mass.
- Leptin sensitizer/fat burners - Leptin sensitizers work to help your body more efficiently use leptin to burn fat.
- Energy boosters - Energy boosters help increase metabolism.
- Probiotics - Probiotics can influence how many calories you absorb from the food that you eat as well as impacting your hormones.
- Fish oil - Fish oil helps reduce inflammation and assists in building lean muscle mass as well as burning fat mass.
- Appetite managers - Appetite managers help you stay on track and keep eating healthy whole foods!
Wrapping it up
My own personal experience tells me that many patients can benefit from prescription weight loss medications.
Does everyone need them? No!
But can they help get you to your target weight faster? Yes!
Before you consider using any prescription weight loss medication you should take a good look at its side effect profile and consider if those side effects are worth the risk for YOU.
If you have more than 50 pounds to lose then the side effects then using weight loss medications are almost always worth it.
The reason is simple:
Those 50 pounds are guaranteed to cause problems for you down the line including a whole host of health issues.
It's far better to trade some temporary side effects now in an effort to prevent virtually guaranteed medical conditions later in life.
But I'm not you, so make sure you do your own research!
Finally, don't forget to add in other healthy habits such as changing up your diet, exercising regularly, taking the right supplements, and getting enough sleep.
These things will have a synergistic effect on your weight and will help you lose more weight.
Now I want to hear from you:
Are you considering using any of the prescription weight loss medications listed above?
Have you already used them? Did they work for you?
Did you experience any side effects while trying them?
Do you think that the side effects are worth it in your situation?
Leave your questions or comments below!
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