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This week’s blog will discuss losing weight with a strategy other than a diet: medications.

Weight loss medications have always been notorious for the dangers associated with amphetamine-related components. But not all medications are amphetamine-related. There are new medications related to Selective Serotonin Reuptake Inhibitors (SSRIs), safer antidepressants. There is one medication that has gained some fame recently, Contrave. 

Contrave uses a combination of Welbutrin and Naltrexone. Naltrexone is used for narcotic or alcohol addiction; Welbutrin, also known as bupropion, is used for depression and smoking addiction. Another example of non-amphetamine-related weight loss medication is Orlistat, which works by blocking the digestion of fats. 

 

 

If we usually focus on heart disease and insulin resistance prevention, why are we talking about weight loss medications? The obesity epidemic has created considerable increases in type 2 diabetes, heart attack, stroke, and other significant negative health impacts.

I don’t run a weight loss clinic. I run a heart attack and stroke prevention clinic. In almost 30 years of practice, I never prescribed a weight-loss medication, and that was because they were always based on amphetamine-related drugs.

 

 

However, now there are other options with different mechanisms that are more likely to be safer. Several of them are related to anti-addiction medications like naltrexone and Welbutrin, and since they are also associated with SSRIs, they are safer than amphetamine-related medications. 

I’ve used one of them, Contrave; the intended mechanism decreases appetite and the addictive relationship with food. Although talking about some of the side effects is inevitable, Wellbutrin was not intended to reduce weight; loss of appetite is a side effect. It’s not surprising that they would put it in with naltrexone to create a weight loss pill.

Other side effects of contrave are constipation, dizziness, headache, nausea, and vomiting; however this are not significant side effects; on the other hand, the impact of the medication is 5-10% loss of body weight per year compared to placebo, which is an excellent gentle, makes benefits outweigh risks and is actually a steady way to lose weight.  

 

 

A similar medication is called Orlistat,  also known as Alli. It works by blocking the enzyme that breaks down fats in your diet. The fat passes out of your body in the bowel movement. It does not preclude the absorption of calories from sugar or protein. You still have to restrict your caloric intake. Since it stops digestion of a significant portion of your diet-fats, it creates flatulence, gas, and sometimes cramping.

There are other new medications, some of them including phentermine, like Qsymia. It has pretty different medicines, and I have not used phentermine-related drugs; but  safety is still questionable.

I’ve used some medications that decrease weight in my patient population, and that is because I see many patients with diabetes, so I use GLP-1 agonists. Byetta was one of the originals; there are others like Victoza and Saxenda; both are generic names and liraglutides. These are all primarily antidiabetic medications; they decrease blood sugar by impacting hormones like blip (Beta-lactamase inhibitor protein), which reduces appetite. 

 

 

The bottom line is weight loss is an essential aspect of cardiovascular prevention; I usually focus on diet and exercise, but some medication might be helpful. I have used Contrave, Orlistat is another alternative, and of course, GLP-1 agonist might have positive effects that should be considered. 

 

REFERENCES:

  1. https://www.hsph.harvard.edu/nutritionsource/an-epidemic-of-obesity/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138366/

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