What’s the Latest on Medications to Manage Weight?
Why Do We Care About Weight Management Medications?
Weight management medications are prescription medications that are designed to help people lose or manage their weight. They work by affecting the body's metabolism, appetite, or absorption of nutrients.
For some individuals, weight management medications can be really helpful.
In this blog post, we'll take a closer look at weight management medications and what you need to know if you're considering using them.
We will answer:
What are weight management medications and how do they work?
Should I take weight management medication?
Top tips to get the most out of your weight management medication
Common pitfalls when using weight management medications
When should I stop taking weight management medications?
How to treat the common side effects of weight management medications.
What Are Weight Management Medications and How Do They Work?
Different weight management medications work differently, however most of the newer generations will manage appetite and fullness.
Here is a rundown of the weight management medications being used in Australia and how they work:
New
Liraglutide (Saxenda) and semaglutide (Ozempic/Wegovy): Liraglutide and semaglutide are glucagon-like peptide-1 (GLP-1) receptor agonists that work by mimicking the action of the natural hormone GLP-1. GLP-1 helps regulate blood sugar levels and can also reduce appetite.
Naltrexone/bupropion (Contrave): Naltrexone/bupropion is a combination medication that works by reducing appetite and cravings. Naltrexone is an opioid receptor antagonist that is typically used to treat opioid addiction, while bupropion is an antidepressant that can also help reduce cravings.
Phentermine/topiramate (Brand name Qsymia in the US; compounded in Australia): is a combination of two drugs, phentermine and topiramate. Phentermine is a sympathomimetic amine that works by decreasing appetite and increasing the release of certain neurotransmitters in the brain, while topiramate is an anticonvulsant medication that can also help reduce appetite and increase feelings of fullness.
Coming Soon
Tirzepatide (Mounjaro): Tirzepatide is a new medication for the treatment of type 2 diabetes. It is a once-weekly injectable peptide that combines the actions of two hormones, glucagon-like peptide-1 (GLP-1) receptor agonist and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. By activating the GLP-1 and GIP receptors, tirzepatide can stimulate insulin secretion, reduce glucagon release, slow down gastric emptying, and promote a sense of fullness. Clinical trials have shown promising results for reduction in body weight compared to other diabetes medications or placebo, however it is yet to have approval for weight management, and is not currently available in Australia.
Older Agents
Orlistat (Xenical): Orlistat is a lipase inhibitor that works by blocking the absorption of dietary fat in the intestine. This reduces the number of calories the body can absorb, leading to weight loss over time.
Phentermine (Duromine): Phentermine is a sympathomimetic amine that works by decreasing appetite and increasing the release of certain neurotransmitters in the brain, such as norepinephrine and dopamine. This leads to a reduction in hunger and an increase in feelings of fullness.
Should I Take Weight Management Medications?
There is currently a lot of hype around weight management medications. It would seem as though they are in the news on a daily basis be it due to shortages, or because the latest Tik Tok celebrity has been using them.
But how do you know if they are right for you?
Here are some points to consider:
BMI
Whilst BMI shouldn’t be used on it’s own as a marker of health, the guidelines for weight management medications typically only recommend their use in individuals with a body mass index (BMI) of 30 or higher, or for those with a BMI of 27 or higher who also have weight-related health problems such as diabetes, high blood pressure, or high cholesterol. This is based on a population level risk vs benefit equation. With any medication there is the possibility of side effects, and with a BMI under 30 and no weight related medical issues, it has been determined that the risks of taking the medication likely outweigh the benefits.
How Much Weight Are You Hoping to Lose?
It is important to have realistic expectations of what degree of weight loss a weight management medication can help you with. The amount of weight loss depends on which medication, the dose, the degree of lifestyle changes that you can make and individual response to the medication. On average, depending on the medication, it will be in the range of 5-20% of your total body weight. This means that a person who has a starting weight of 100kg, may lose between 5kg, and 20kg. The good news is that, for most medical issues related to weight, this amount of weight loss is enough to see significant improvements if not complete resolution.
Is Now The Right Time?
Using weight management medications involves making positive lifestyle changes to continue with for the rest of your life. Start at a point where you will have the time, motivation and support to use the medication to help you to make necessary positive dietary changes and set up healthy lifelong habits. If you are unsure as to whether now is the right time, it is important to discuss this with your doctor.
Do You Know What You ‘Should’ Be Eating?
Many individuals are plagued by constant doubt as to whether they are doing the ‘right’ thing with their diet, or feel they’re either always ‘on’ or ‘off’ a diet which can be tiring. It is helpful to work alongside a dietitian when taking weight loss medications to ensure you are making sustainable and realistic dietary changes. It is important to ensure that you are getting enough protein and fibre, calcium and other nutrients from your diet to maximise fat loss and to not compromise your health.
How Is Your Mental Health?
Disordered eating patterns, including binge eating disorder, eating for comfort, eating for boredom, feelings of self sabotage with eating are unfortunately quite common. If you think that you may be struggling with disordered eating, it is essential that you have help from a dietitian and psychologist for this prior to starting weight loss medications. Feel free to complete this online questionnaire if you are concerned that you may have some disordered eating patterns and we can help you access the assistance that you need:
https://www.cognitoforms.com/NoiClinic/EatingDisorderExaminationQuestionnaireEDEQ
Personal Preferences
Weight management medications are not the right choice for everyone. Some individuals may prefer to focus on lifestyle changes alone, some would prefer surgery. These are valid choices and yours to make. We can help you determine if weight management medications align with your personal preferences and goals.
Top Tips To Get the Most Out of Weight Management Medications
Weight management medications can be a useful tool for individuals struggling to manage their weight. However, they are not a quick fix. It is important to use these medications to set up healthy habits for life.
Here are our top tips for using weight management medications:
Discuss the Options
Although there is a lot of media attention currently on one type of weight management medication, there are different options. It is important to know about all of these so that you use the best and safest option for you.
Discuss Realistic Expectations
How much weight can this medication help me lose? Is that realistic for me?
Start At the Right Time
The medication needs to work in your day to day life (this is not a quick fix), however considering if it’s the ‘right’ time for weight loss to be your focus is important. Are you about to go on a holiday? Do you have upcoming surgery? Have you just had a baby? Are you struggling with disordered eating? It may be time to focus on other aspects of your health (such as getting more sleep!) and may not be the ‘best’ time to start medications to manage your weight. Discuss the optimal time to start medications with Dr Rosie or your prescribing doctor.
Be Patient
Weight loss takes time and weight management medications are not a quick fix. There is no such thing as urgent weight loss. Whilst it may be tempting to lose weight prior to a major event, if your dietary choices and lifestyle habits aren’t sustainable you run the risk of weight regain.
Less is Not Necessarily More
Weight management medications help you feel less hungry and the temptation is to just eat less food. This can lead to muscle mass loss, vitamin and mineral deficiencies and can affect your gut and bone health and ultimately weight regain over time. Use the time on the medication to optimise your dietary choices and behaviours for best weight loss and health outcomes long term. Our dietitian, Caroline Shannon, is an expert in making sure you get the most out of the weight loss medication, whilst not jeopardising your health.
Exercise Regularly
Many individuals I chat to feel that exercise has not helped them with managing their weight. It is important to find the right exercise for you to help lose fat and build muscle. And don’t forget, regular exercise can do far more than just support weight loss. Regular physical activity can help manage weight, reduce the risk of chronic diseases such as diabetes and heart disease, and improve mental health. Exercise can also increase strength and flexibility, improve balance, and reduce the risk of falls in older adults. Additionally, regular exercise can improve sleep quality, boost energy levels, and enhance cognitive function. Exercise can be an enjoyable way to socialise with others and can provide a sense of accomplishment and satisfaction. So keep focused on the additional benefits of exercise aside from weight loss to help with the motivation to maintain consistency.
Use the Time Wisely
If you were to have one take away, it may be this. You may only get one chance for a given medication to work at its maximum potential. We know that the effects can lessen over time, and this might be your one ‘bite of the cherry’! Make sure you have all the knowledge and support to use the medication to set up healthy dietary patterns for life. Sustainability is key.
Common Pitfalls When Using Weight Management Medications
Weight management medications can be a helpful tool in your weight loss journey, but it is important to be aware of potential pitfalls:
Relying Solely on Medication to Achieve Weight and Health Goals
Weight management medications work best when used in combination with improvements in your baseline regular exercise and a healthy diet. Make sure you get specialised support to maximise these changes to get the most out of the medication.
Assuming Side Effects are Necessary or Helpful
Weight management medications have been found to be effective without nausea! Be sure to let us know of any side effects.
Overestimating the Efficacy of the Medication
Realistic expectations are very important. Not understanding how much weight these medications can help you lose may set you up to feel like a failure. Discuss your goals with Dr Rosemary Atkinson or your GP before you start.
Not Making Sustainable Dietary Changes
While weight management medications can be effective in the short-term, long-term success requires sustainable lifestyle changes. It is important to develop a personalised weight management plan with our dietitian, Caroline Shannon, that includes sustainable dietary changes that you can manage and maintain for life.
Not Considering the Cost
Weight management medications can be expensive, and no medications when used for weight management are covered by the PBS. Some policies of private health insurance cover some medications. Given the length of time these medications need to be used for, it is important to consider this ongoing cost.
Not Taking the Medication as Directed
Weight management medications are prescription medications and should only be taken as directed. There is the recommended dosage as per the manufacturer, however in consultation I may suggest a lower dose. Be sure to follow the instructions carefully.
Stopping Too Soon
If weight medications are tolerated and effective, they then need to be taken for the mid to long term. Individualised details around the best time for you to stop need to be discussed with Dr Rosemary Atkinson or your treating practitioner.
Not Getting Enough Sleep
Poor sleep can lead to weight gain, as it disrupts hormones that control hunger and fullness. We often compensate for tiredness by reaching for high calorie foods. And we are less likely to be physically active if we have not had a good night's rest. Aim for at least 7-8 hours of sleep per night.
Not Managing Stress
Chronic stress can lead to less nutritious food choices, overeating and weight gain. Practice stress management techniques such as meditation, yoga, or deep breathing exercises. If the amount of stress feels overwhelming, our psychologist Lareena Brown can help.
Drinking Too Much Alcohol
It is easy to forget that alcoholic beverages are high in calories. And we also know that alcohol can affect our ability to make good decisions and ‘healthy’ choices. Limit your alcohol intake where possible.
When Should I Stop Taking Weight Loss Medications?
The duration of treatment with weight loss medications varies depending on the specific medication, the individual's response to treatment, and any potential side effects.
In general, weight loss medications are initially prescribed for a limited period of time initially, typically 12 weeks, to determine tolerability and efficacy. This is broadly determined by the loss of 5% of body weight in 3 months, although there is nuance to this.
After this initial period, it can be determined whether to continue or stop the medication.
If the decision is made to continue, the evidence with respect to treatment of weight challenges now suggests that we really need to continue the interventions we start at least for the medium term. Trials are ongoing for the newer medications, such as semaglutide (ozempic/wegovy), but they all show a trend of weight regain if stopped quickly.
Everyone at any given time has a ‘set point weight’ - the weight where the body seems to sit quite comfortably. You can lose weight over the short term, but ultimately through hormonal mechanisms resulting in, amongst other things, increased hunger, your body will then quickly return to its previous weight - or sometimes even higher.
The aim of any weight management medication is to counteract the body’s mechanisms driving weight regain after weight loss. How long these drivers continue for, is still under investigation and likely will depend on individual factors.
In conclusion, it is important to understand that if you tolerate medication and it works well for you, you may be on it for the medium to long term. The goal will then be to use the medication to help with developing ongoing positive habits to set you up for life.
What Are the Potential Side Effects of Weight Management Medications?
Weight management medications can be a useful tool for individuals struggling with weight issues. However, like any medication, these drugs can come with potential side effects.
Here is a guide on managing the more common side effects of weight management medications:
General Advice
Talk to your healthcare professional: Before starting any weight management medication, discuss the potential side effects with your healthcare professional. They can provide information on what to expect.
Be patient: Most side effects of weight management medications are temporary and will improve over time.
Side effects are not what makes the medication effective. You do not need to tolerate continued unpleasant symptoms to lose weight.
Be aware of common side effects: Common side effects of weight management medications may include nausea, constipation, diarrhoea, headache, and dry mouth. Less common side effects include mood disturbance (low mood, anxiety).
Report any unusual symptoms: If you experience any unusual or severe symptoms, such as chest pain or difficulty breathing, contact your healthcare.
Tips For Nausea
Eat small meals: Eating small meals throughout the day can help manage nausea and reduce the risk of vomiting.
Avoid trigger foods: Certain foods can trigger nausea. Avoid spicy, greasy, and high-fat foods when taking weight management medications.
Drink plenty of fluids: Staying hydrated can help reduce nausea. Drink plenty of water or other low calorie fluids throughout the day.
Try ginger containing capsules, food or drinks
Take the medication at night: Some weight management medications can cause nausea during the day. Taking the medication at night before bed can help reduce nausea.
Don’t increase the dose until your nausea has settled:: you can increase more slowly than the advised dosing schedule
Go for a walk: fresh air can help with nausea.
Talk to your healthcare provider: If you are experiencing severe nausea or vomiting, they may be able to adjust your medication or recommend other treatments to help manage your symptoms.
Consider alternative medications: If nausea is a persistent problem, your healthcare provider may recommend alternative weight management medications that are less likely to cause nausea. You do not need to have nausea as a side effect for weight loss!
Tips For Reflux
Eat small meals and eat slowly: Eating small meals and not rushing meals, can help manage reflux symptoms.
Avoid trigger foods: Certain foods can trigger reflux symptoms. Trial avoiding common triggers such as fatty foods, chocolate, spicy foods, coffee and alcohol.
Take the medication with plenty of water: Drinking plenty of water with an oral medication can help dilute the medication and reduce its potential to irritate the oesophagus.
Avoid lying down after taking the medication: Wait at least 30 minutes to 1 hour after taking the medication before lying down. This can help prevent reflux symptoms by allowing the medication to pass through the stomach and into the small intestine before lying down.
Stopping smoking: a study of people taking a regular medicine for reflux found that stopping smoking almost halved the severity of their reflux symptoms.
Avoiding eating immediately before vigorous exercise.
Elevate the head of your bed: Elevating the head of your bed by 20cm can help prevent reflux symptoms during the night.
Talk to your healthcare provider: They may adjust the dose of your medication or recommend other treatments to help manage your symptoms.
Consider alternative medications: If reflux is a persistent problem, your healthcare provider may recommend alternative weight management medications that are less likely to cause reflux.
Tips For Constipation
Use a stepwise progression of treatment:
a. First, increase fluids and dietary fibre. A dietitian can help determine your fibre requirements and discuss ways to increase fibre in your diet.
b. Consider adding in a fibre supplement (benefiber/metamucil).
c. If needed, you can use an osmotic laxative such as Movicol or lactulose.
d. If no improvement, you may need to use a stimulant laxative for the short term: examples include coloxyl with senna, prunelax.
If there is no improvement in symptoms using the above after 2-3 days, talk to your healthcare provider: They may adjust the dose of your medication or recommend other treatments to help manage your symptoms.
Tiredness
Drink plenty of fluids: mild dehydration can cause tiredness.
Eat a healthy diet: Eating a healthy diet can help maintain energy levels throughout the day. Aim for a balanced diet that includes whole grains, fruits, vegetables, lean proteins, and healthy fats. A diet low in protein can affect energy levels. A dietitian can help ensure that you are hitting your protein and other nutrient targets.
Take the medication at night: Some weight loss medications can cause tiredness during the day. Taking the medication at night before bed can help reduce tiredness during the day.
Get enough sleep: Getting enough sleep is essential for managing tiredness. Aim for 7-9 hours of sleep per night.
Exercise regularly: Exercise can help boost energy levels and reduce fatigue. Aim for at least 30 minutes of moderate intensity exercise most days of the week.
Take breaks: Taking short breaks throughout the day can help reduce tiredness. Take a walk, stretch, or simply rest your eyes for a few minutes.
Consider low mood, stress or motivation as a cause of tiredness: some weight management medications can cause low mood. Motivation can wax and wane over a weight loss journey. Talk to your prescribing doctor if you feel that these factors may be contributing to your symptoms.
Talk to your healthcare provider: If you are experiencing severe tiredness or fatigue, talk to your healthcare provider. They may be able to adjust your medication or recommend other treatments to help manage your symptoms.
Site Reactions for Injectables
Site reactions, such as redness, itching, and swelling, can be side effects of injectable weight management medications. Here are some tips for managing site reactions:
Use a new needle: make sure to use a new needle every time. If you are running low on supplies, more needles can be obtained from your pharmacist.
Rotate injection sites: Rotate injection sites to avoid injecting the medication into the same area repeatedly. This can help reduce the risk of developing site reactions. Some sites can work better than others, the area around the umbilicus (belly button) can be more sensitive to bruising, tenderness and site reactions.
Keep the injection site clean: Keeping the injection site clean can help prevent infection. If required, wash the area with soap and water before and after injecting the medication. Do not use alcohol swabs, as these can worsen site reactions, and are not necessary.
Wait for the click and then count: when delivering the dose, wait 3 seconds from the ‘click’ before removing the pen
Apply a cold compress: Applying a cold compress to the injection site can help reduce swelling and relieve itching.
Use topical treatments: Over-the-counter topical treatments, such as hydrocortisone cream, can help relieve itching and inflammation.
Talk to your healthcare provider: If you are experiencing severe site reactions, talk to your healthcare provider. They may be able to adjust your medication or recommend other treatments to help manage your symptoms.
Be aware of potential allergic reactions: Some people may be allergic to injectable weight management medications. If you experience symptoms such as hives, difficulty breathing, or swelling of the face or throat, seek emergency medical attention.
Managing side effects of weight management medications can be challenging, but it is important to remember that most of these side effects settle with time.
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