6 weight loss medication options

Overview of weight loss medications

There are currently six drugs approved by the Food and Drug Administration (FDA) for chronic weight management:

• Orlistat (Alli, Xenical)
• Phentermine (Lomaira, Adipex, Suprenza)
• Naltrexone-bupropion (Contrave)
• Liraglutide (Saxenda, Victoza)
• Semaglutide (Wegovy)
• Tirzepatide (Zepbound)

  Note: Ozempic, another semaglutide, is not currently approved for weight loss specifically. Neither is Rybelsus, the pill form of the same medication. Mounjaro is also not approved for weight loss.

Some of these weight loss medications are administered by subcutaneous injection while others are taken as an oral pill. Injections are generally given weekly or daily, typically in the abdomen, while pills are taken one to three times per day.

Consumers also have the option of an over-the-counter (OTC) weight loss drug. OTC medications are less regulated than prescription medications but can be effective for many people.

Currently, the only FDA-approved OTC weight loss drug is Alli, which uses a 60-milligram dose of orlistat versus 120 milligrams in its prescription counterpart, Xenical. Alli is approved for adults with a BMI over 25, whereas Xenical is approved for those with a BMI over 30 or over 27 with other risk factors like diabetes and hypertension.

For those who are obese or have weight-related risk factors, a prescription medication will likely be more effective than an OTC since it contains a stronger dose of the active ingredient and you’ll have the oversight of a doctor who can make medication adjustments based on your goals and health needs.

Those with a BMI under 30 and who are looking for a more accessible, less expensive alternative may want to try the OTC option. In either case, you should consult with your health care provider before taking any new medication.

Prescription weight loss medications

Two of the most popular prescription weight loss drugs are glucagon-like peptide-1 (GLP-1) receptor agonists and phentermine. GLP-1s were initially approved to treat type 2 diabetes, but they’re also effective at reducing food intake and work by activating the body’s GLP-1 receptors, which reduces blood sugar levels. In 2014 the FDA approved liraglutide, the first GLP-1 approved solely for weight loss.

Phentermine was first approved by the FDA in 1959 to address obesity and works by decreasing your appetite. While phentermine is only approved for short-term use of 12 weeks or less, many doctors will prescribe it for longer-term use, according to the Mayo Clinic.

However, other weight loss medications may be right for you and you should discuss all options with your health care provider since each has a different effect on the body. Effects can include:

• Increasing insulin secretion
• Suppressing appetite
• Reducing fat absorption
• Decreasing cravings
• Increasing fullness

How to choose the right weight loss medication

Choosing a weight loss medication should only be done under the guidance of a licensed health care provider who can provide oversight and help you compare the benefits and drawbacks of each option. You’ll also need to consider the potential side effects and whether you have health conditions that could interact with the drug, making it unsafe to use.

If you’re only trying to lose weight to look better, your doctor may recommend lifestyle changes in lieu of medication, since these drugs are intended to treat weight-related health issues associated with obesity. Or, if you have a BMI under 30 and no serious weight-related health risks such as diabetes or high blood pressure, you may want to consider an OTC medication instead of a prescription drug.

Below are some factors to keep in mind when selecting a weight loss medication:

• Potential interactions with other medications, vitamins or supplements you’re taking
• Your personal health history and health goals
• Your BMI
• Your family’s medical history
• Potential side effects
• The lifestyle changes you’ve already made to address your weight
• Personal preference of an oral pill versus an injection
• The cost of the medication

Effectiveness of weight loss medications

Numerous studies show that prescription weight loss drugs are effective when combined with other lifestyle changes. According to clinical trials looking at different weight loss drugs, patients can expect to lose 5% to 15% of their starting body weight.

In addition to weight reduction, one study also shows that those with a preexisting cardiovascular condition and were overweight but who didn’t have diabetes and who took semaglutide (a GLP-1) for a mean duration of 33 months saw heart health improvement and had a 20% reduced risk of a “composite death from cardiovascular causes, nonfatal cardiovascular causes, and nonfatal stroke.”

While some clinical studies point to injections being more effective than oral pills, the data appear to be changing. Current trials underway for GLP-1 oral pills find they’re equally as effective for weight loss as injectables and many patients like the ease of a pill over an injection.

Whether taken orally or by injection, these drugs aren’t intended as a sole intervention, and the best results occur when both medication and lifestyle interventions, including dietary and exercise, are made simultaneously.

Safety and side effects of weight loss medications

Some of the most common side effects when taking weight loss drugs are mild gastrointestinal (GI) related issues such as

• Nausea
• Diarrhea
• Acid reflux
• Bloating
• Constipation
• Stomach pains
• Headaches
• Increased heart rate
• Increased blood pressure
• Insomnia
• Nervousness
• Depression
• Suicidal thoughts

Many of these side effects will slowly dissipate or lessen as your body adjusts to the new medication.

Some of the more mild GI side effects can be managed by staying hydrated, eating smaller meals, limiting greasy foods and ensuring a high-fiber diet. However, if your symptoms don’t abate or you experience more acute symptoms like severe vomiting and diarrhea or jaundice, you should contact your doctor right away.

More rare but severe side effects for GLP-1 receptor agonist class drugs can include: medullary thyroid cancer, pancreatitis, acute (sudden) kidney injury and worsening diabetes-related retinopathy, according to Cleveland Clinic. There have also been case reports of gastroparesis (stomach paralysis).

When starting any new medication, you should be closely supervised by your medical provider to ensure the side effects are tolerable. If they aren’t, you should either stop taking the medication, change the dosage or try a different kind of medication.

Bottom line

Weight loss medications are incredibly popular, but that doesn’t mean they’re the right option for everyone, even those with a BMI over 30. That said, they can be very effective and if you’re interested in learning more, you should consult with a doctor. These conversations should include a discussion about your weight loss goals, the potential side effects and safety concerns of each drug and the importance of using medication as part of a comprehensive weight loss plan.

As research continues to be done, it’s likely that new FDA-approved weight loss medications will find their way into the market, including more options for oral pills. All signs point to the future of weight loss drugs continuing to grow along with demand.