Newly Approved Weight Loss Drugs: Can They Help You?

New weight loss medications have recently come into the marketplace - the first in over a decade. But are these pills the cure-all for the obesity epidemic in the U.S? Here, review recent statistics on the expanding waistline of the nation, how to calculate your body mass index (BMI), and facts on some new and not-so-new weight loss treatments. And yes, just in case you were wondering, diet and exercise are still part of the prescription.

The Obesity Crisis: A National Epidemic

According to the U.S. Centers for Disease Control and Prevention (CDC), there has been a dramatic increase in obesity in the last 20 years. More than one-third of U.S. adults and roughly 17 percent of children and teens are obese.

These numbers are especially astounding because obesity is the second leading cause of preventable deaths in the U.S. In addition, being overweight or obese is a recognized risk factor for many health problems including diabetes, high blood pressure, heart disease, stroke, osteoarthritis, sleep apnea and certain cancers.

The Skinny on Weight Loss: Is There a Magic Pill?

The quest for a magic weight loss pill has been elusive to date. While many pills claim to lead to weight loss, in reality, it is the hard work of diet and exercise that ultimately leads to healthy and sustainable weight loss. However, when weight loss medications are combined with diet and exercise, as they should be, an added benefit may be seen.

New weight loss agents have recently become available on the U.S. market that can help patients lose 3 to 9 percent of their weight when combined with diet and exercise. Be sure to talk to your doctor for sound advice before starting any weight loss program.

What is a BMI?

Many weight-loss medications are prescribed based on your body mass index (BMI). BMI is a calculation of your weight in relation to your height that defines your health risk. Obesity is defined as a BMI over 30 kilograms/meter squared (kg/m2). A BMI of 25 to 30 is considered overweight, and a BMI of 18.5 to 24.9 is considered healthy.

In general, you should not use weight loss medications unless you are at risk for a health-related condition. A low-fat diet and regular exercise are part of the weight-loss regimen that should be continued even if weight loss medicines are stopped.

How Do I Calculate My BMI?

To calculate your BMI you must know your weight in pounds and height in inches. You can use a reputable online BMI calculator or calculate your own BMI:
  1. Multiply weight in pounds by 703.
  2. Divide that answer by height in inches.
  3. Divide that answer by height in inches again.
See the example slide here using 160 pounds for weight and 66 inches for height. Your answer, using your unique weight and height, should correspond to one of the BMI Risk Categories found on the previous slide.

Update: The New Weight Loss Drugs Qsymia and Belviq

In 2012, the FDA approved the first two new weight loss drugs in 13 years - Qsymia by Vivus Pharmaceuticals and Belviq by Arena Pharmaceuticals. The effectiveness of Qsymia and Belviq has not been compared in clinical trials, but each drug has been tested against a placebo, or sugar-pill. For Qsymia, weight loss was on average 8.9 percent greater than for those taking placebo. Adults taking Belviq had an average weight loss that was 3 to 3.7 percent greater than placebo.

Both Qsymia and Belviq are C-IV controlled substances. Neither drug is approved for use in children.

How Does Qsymia Work?

Qsymia is a combination of two drugs, phentermine and extended-released topiramate. Phentermine acts to suppress the appetite, and topiramate is an anti-seizure medicine that may help people feel full.

The drug is used for weight control in two groups: either those who are obese (BMI of 30 or higher), or those who are overweight (BMI of at least 27) and also have at least one weight-related condition, such as type 2 diabetes, high blood pressure, or high cholesterol. The Qsymia dose is taken once daily in morning; patients should avoid an evening dose as it may keep them awake.

Important Facts About Qsymia

Qsymia may cause birth defects, so do not use Qsymia if you are pregnant or planning a pregnancy. Women will need a negative pregnancy test before starting Qsymia and each month on therapy. Use an effective birth control to prevent pregnancy; discuss your birth control options with your provider.

Do not use Qsymia if you have glaucoma, thyroid disease or use monoamine oxidase inhibitor drugs. If you have not lost a certain percent of your weight after 12 weeks, your doctor may decide to stop Qsymia treatment, but you may need to stop treatment slowly.

What Are the Most Common Side Effects with Qsymia?

Common side effects with Qsymia may include
  • numbness or a tingling sensation
  • dizziness
  • unusual taste
  • difficulty sleeping
  • constipation
  • dry mouth
Mood problems, difficult concentration, and low blood sugar in patients with type 2 diabetes may also occur. It is not known if it is safe to take Qsymia with other prescription, over-the-counter or herbal weight loss medications; talk to your doctor or pharmacist before you combine any medications.

How Does Belviq Work in Weight Loss?

Belviq (lorcaserin) is a serotonin 2C brain receptor agonist that helps people feel full after eating less. Belviq is available by prescription in your pharmacy, and is classified as a C-IV controlled substance, meaning it has a lower level for abuse or drug dependence.

Belviq is approved to be used in the same two patients groups as Qsymia: either obese patients, or overweight patients with at least one weight-related condition. Patients taking Belviq should not exceed a dose of 10 mg two times a day. Exceeding the normal dose may lead to psychiatric side effects.

Belviq Safety Facts

Belviq should be discontinued if a person fails to lose at least 5 percent of their body weight after 12 weeks of treatment. Like Qsymia, the safety of taking Belviq with other prescription or OTC weight loss drugs is not known.

There is the possibility of dangerous drug interactions with Belviq because it acts on the serotonin system in the brain. It is important to have a thorough drug interaction review with your doctor or pharmacist, reviewing over-the-counter, vitamin and prescription drugs, when you start Belviq and any time a new medication is added or stopped.

Common Side Effects with Belviq

Common side effects may include
  • headache
  • nausea
  • dizziness
  • fatigue
  • dry mouth
  • constipation
As with Qsymia, hypoglycemia (low blood sugar) may occur in type 2 diabetic patients; in general, weight loss is associated with a drop in blood sugar.

Belviq should not be used if you are pregnant because weight loss in pregnancy can be dangerous for the baby.

Alli: A Lower-Dose, OTC Version of Prescription Xenical

Alli (orlistat) is the OTC version of the FDA-approved prescription drug Xenical, but it comes in a lower 60 milligram (mg) strength. Alli should be used in conjunction with diet and regular exercise to promote weight loss. Alli decreases the absorption of dietary fat by about 25 percent and therefore reduces the number of calories absorbed. However, clinical trials have only shown it to be modestly effective; in general, a weight loss of 3 to 5 pounds per year would be expected over and above what you might lose from dieting and exercise alone. Alli should be used in adults only and do not exceed three capsules per day.

Alli: Use and Side Effects

Alli is taken as one 60 mg capsule three times a day. Take Alli with a meal that contains no more than 15 grams of fat to help limit stomach side effects. It is also recommended to take a daily multivitamin at bedtime to help offset the loss of any fat-soluble vitamins. Those with diabetes, thyroid disease or taking a blood thinner should consult with their doctor before using Alli.

Side effects with Alli often hinder its use: loose stools, oily spotting, gas, bowel incontinence, and rare liver injury may occur. Symptoms of liver injury include yellow skin or eyes, itching, brown urine and stomach pain.

Stimulant Weight Loss Drugs

Drugs that are considered stimulant weight loss drugs include phentermine (Adipex-P), phendimetrazine (Bontril SR) and diethylpropion. These are controlled sustances approved for short-term use in weight loss - usually only up to 12 weeks - because these drugs can lead to abuse and dependence with long-term use. As with other weight loss treatments, these drugs should be used in conjunction with diet and exercise to maintain weight loss.

Often, the weight that is lost with stimulants may be regained when the medication is stopped. In contrast, Alli, Belviq, and Qsymia are all approved for long-term use in weight loss.

Are OTC Herbal Weight Loss Pills Safe and Effective?

Chromium, Green Tea extract, Hoodia, are Guar Gum are just a few of the herbal dietary supplements available on the market today. It is tempting to buy OTC weight loss pills - they seem quick, easy and may claim to be "natural". However, dietary or herbal supplements are not reviewed by the FDA like prescription drugs and may contain unknown chemicals that can be dangerous or even counterfeit. FDA does investigate OTC supplements if they appear to be causing harm; FDA removed dietary products with the stimulant ephedra from the market in 2004 due to dangerous side effects like heart attack, stroke and seizures.

Finished: Newly Approved Weight Loss Drugs: Can They Help You?

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