Wegovy is cleared for reducing cardiovascular risk and fatty liver disease, while Zepbound is approved for sleep apnea. Crable added that new direct-to-consumer programs from Eli Lilly and Novo Nordisk — which let patients pay cash for treatments at less than half their monthly list price — may also discourage employer coverage. Employers, which can experience high turnover, are also hesitant to cover costly drugs for workers who may leave the company within a few years, Crable added. Novo Nordisk in June said some mass, so-called 503B compounding pharmacies have scaled back production, but accused others — including those tied to Hims & Hers — of continuing to sell the drugs under the "false guise" of personalization. Those decisions legally barred compounding pharmacies from making and selling copycats of those drugs by deadlines that passed earlier this year, except in rare cases where it's medically necessary. Johnson says he hasn’t experienced fat stigma the way Cliett says she has, but for him, losing weight isn’t a health issue alone, even if it’s his primary reason for trying to lose weight. People in the Phase 3 study of Wegovy saw their weight loss taper significantly around week 60. “If they lose 5% of their weight, only 5%, their risk of developing diabetes goes down by 60%. She says that for as many people who will feel stigmatized by calling fat a disease, there are those who won’t be. The U.S. Food and Drug Administration (FDA) has approved a few prescription drugs for long-term weight loss use. There is strong evidence to suggest that obesity management is beneficial for the treatment of T2DM.8 Table 2 summarises the common antidiabetic agents used, based on their effects on body weight. Two other weight loss medications approved in the US but not available in Australia include a naltrexone/bupropion combination and lorcaserin. A large RCT has found that liraglutide 3 mg leads to 5.6 kg (5.4%) weight loss over placebo after one year.19 There were corresponding improvements in cardiometabolic risk factors, including inflammatory markers, glycaemic parameters, blood pressure and lipid levels. Orlistat, phentermine and liraglutide have been approved by the Therapeutic Goods Administration (TGA) for the treatment of obesity in Australia, and topiramate is an effective off-label agent that is currently available for the management of epilepsy and migraine. Rarer side effects include allergic reactions, pancreatitis and acute kidney injury. “A small number of patients have such significant nausea and vomiting that they cannot take this medicine.” They will see how you respond at each dose. Either way, drug companies will be among the winners, Willett said. The type of foods we eat alter dozens of hormones, hundreds of metabolic pathways, and the expression of myriad genes throughout the body in varying ways. Beyond generic interventions like making physical activity more convenient, we must take a more sophisticated approach to investigating the biological effects of diet. They’re huge moneymakers for drug companies, surgeons, and hospitals,” Ludwig said. However, reimbursement is better for semaglutide when prescribed at the lower dose levels to treat diabetes.This medication is also not suitable for patients with a history of certain thyroid cancers or multiple endocrine neoplasia type 2.Few drugs based off the other targets have made it into clinical trials.It’s also contraindicated in cases of glaucoma, history of drug or alcohol misuse, and agitated states.Importantly, topiramate should not be combined with other drugs that inhibit carbonic anhydrase.Still, some drugmakers have made strides over the last year and a half, inking deals with obesity biotechs or releasing promising data on experimental treatments. Saxenda and Wegovy are in a class of drugs called GLP-1 agonists, which mimic glucagon-like peptide 1, a gastrointestinal hormone that helps regulate glucose. Companies marketing and developing new drugs think they can overcome those long-standing issues plaguing the field. While it can cause constant diarrhea for some, it was the first of several drugs allowed to be taken long term. Any weight-loss medicine should be taken along with lifestyle changes, such as exercise and a healthy diet – not in place of them. There are many types of prescription weight loss medicines that work differently to help with weight loss. If you're trying to lose weight, our experts offer advice on when it's the right time to start a medication. “Because of the way obesity has been created,” Chastain says, “we see a situation where it’s reasonable to risk people’s lives and quality of life to make us thin.” And on top of that are Chastain and the growing movement to end fat discrimination who question why these drugs have to exist at all. Can weight loss medications really help you lose weight? Because these drugs are on the FDA shortage list, they are able to be compounded. “A long time ago you only saw thin people in magazines and on television before the movement that emphasizes body positivity. “Obesity affects every facet of a patient's life, so when you help them get healthy and lose weight, it changes lives,” Wolver said. “Our internal systems tell us to push against weight loss. Energy expenditure in subjects treated with liraglutide 3.0 mg/d decreased, even when corrected for weight loss (72), which may reflect metabolic adaptation to weight loss. A short-term study (5 weeks) involving individuals with obesity and without diabetes demonstrated that liraglutide 3.0 mg/d suppressed acute food intake, subjective hunger, and delayed gastric emptying (72). Participants with diabetes in the COR-Diabetes trial using bupropion/naltrexone also showed a significantly greater 0.6% reduction in HbA1c from baseline, compared to a 0.1% reduction in placebo (68). These results represent the greatest mean body-weight reduction reported to date for any incretin-based investigational therapy in a clinical trial of this duration.6 This degree of weight loss is comparable to that observed with injectable semaglutide 2.4 mg (Wegovy; Novo Nordisk).3 This article will review 5 key drugs currently in phase 3 trials. This drug isn’t appropriate for most people because obesity usually has multiple causes, not just alterations in single genes. SGLT-2 inhibitors aren't recommended for people who have had diabetic ketoacidosis. But the risk of low blood sugar typically only goes up when a person also is taking another medicine that's known to lower blood sugar. Low blood sugar is a more serious risk linked to GLP-1 agonists. More common side effects often improve after taking the medicine for a while. But not everyone loses weight while taking them. Several weight-loss medicines are available in the United States. In addition, it's likely the weight will be regained when the medicines are stopped. The body mass index or BMI predates the bathroom scale by more than half a century, but it has not changed with the times. Our team will help you understand your insurance coverage and costs before starting treatment. Bupropion/naltrexone can be combined with intensive behavioral therapy (IBT) to achieve even greater weight loss (5.2% with placebo and 9.3% with bupropion/naltrexone) (30). Similar weight loss efficacy was reported in COR-II (25) and COR-Diabetes (68) trials. The primary endpoints were percent change from baseline body weight and the proportion of patients achieving at least a 5% reduction in body weight. The combination tablet of bupropion and naltrexone (trade name Contrave) was FDA-approved for weight loss in September 2014. In 2012, a combination medication of phentermine and topiramate was approved for adult use by the FDA under the name Qysmia. Research has shown that, when combined with a healthy diet and exercise regimen, orlistat can yield anywhere from 3 to 5 percent weight loss over the course of a few months. In rare cases, some people may have an allergic reaction to the drug, or be at risk for a dangerous buildup of lactic acid in the bloodstream. However, the drug is also often prescribed off-label to moderate weight loss. Some medicines are more likely to cause side effects than others. Weight-loss medicines are used long-term along with healthy eating and being more active. Different weight-loss medicines produce different results in each person. Nearly one in four people who come to our program has undiagnosed disordered eating.” Patients who turn to VCU Medical Weight Loss program are desperate for help and Wolver cares deeply about helping them.“That is what I am passionate about,” she said. “We try to look for root causes and help them with that, whether that be challenges with understanding a healthy diet, being able to implement it, barriers to exercise, mental health issues or disordered eating. Generally, follow-up should occur at one-monthly intervals to assess medication tolerance during dose escalation and one-to-three-monthly intervals thereafter to encourage adherence to therapy and assess progress. For patients with a BMI of 30–39.9 kg/m2, without obesity-related complications, supervised lifestyle modification and initiation of pharmacotherapy can be undertaken in the primary care setting. Lifestyle interventions and multidisciplinary support are crucial for successful weight loss. Topiramate is an anticonvulsant that is used off label for the treatment of obesity. Phentermine is contraindicated in patients with cardiovascular disease, cerebrovascular disease and uncontrolled hypertension (Table 1). There are multiple ways that these medications may improve other health conditions. For example, there's evidence that type 2 diabetes can be put into remission with this kind of weight loss. While the journey of weight loss is challenging, the health benefits gained during the period of weight loss are substantial. Phentermine’s and diethylpropion’s main side effects are related to their sympathomimetic properties, including elevation in blood pressure and pulse, insomnia, constipation, and dry mouth (47).The most significant change in lipid profile was in the triglycerides that were reduced by 13.0 mg/dl in the liraglutide 3.0 mg group vs. 5.5 mg/dl in the placebo group.Meta-analyses of olderrandomized controlled trials (RCTs) of lifestyle modifications (i.e. diet andexercise) demonstrate that every 1 kg of weight loss corresponds to a short-term(2–3 year) decline in systolic blood pressure of 1 mm Hg 34, 35.In November 2023, it was approved by the Food and Drug Administration (FDA) under the name Zepbound® for chronic weight loss management.Bupropion/naltrexone can be combined with intensive behavioral therapy (IBT) to achieve even greater weight loss (5.2% with placebo and 9.3% with bupropion/naltrexone) (30).Metsera, a company that was recently bought by Pfizer, is also investigating monthly GLP-1 and amylin analog drugs.Cohen said that drugs like Ozempic have already shown promise in helping with mental health issues, addiction, and obsessive-compulsive disorder. One of the positive aspects of everyone talking about the newer weight loss drugs is that they have helped people who have been shamed and blamed about their weight speak out about the disease. PubMed database was searched using the keywords “pharmacotherapy”, “weight loss”, “FDA-approved”, “orlistat”, “phentermine-topiramate”, “naltrexone-bupropion”, “liraglutide”, and “semaglutide”. Of these medicines, liraglutide (as Saxenda), semaglutide (as Wegovy), and tirzepatide (as Zepbound) are approved by the FDA to treat weight-loss in people without diabetes. Weight-loss medications influence appetite, digestion, or nutrient absorption. These medications typically work by either regulating appetite, slowing digestion, or blocking fat absorption. There is also an in-depth guide which explains weight loss injections in more detail. Patients need to be informed about the cost of these drugs, in addition to discussing efficacy and safety. They are useful during the weight loss phase, but are essential in the maintenance phase. This reinforces the idea that you really need to treat obesity as you would any other chronic disease. Scientists believe this occurs because the medications reduce appetite and they slow down gastric emptying, which can increase a sense of fullness and decrease hunger. Semaglutide is one of several GLP-1 receptor agonists approved to treat diabetes, as second-line agents after metformin. This is true for many medications that control other health conditions. The medication improved her adherence to caloric restriction, and she achieved weight loss of 5 kg. Modest weight loss of 5–10% could result in significant clinical benefit and improvement of Sally’s many obesity-related complications; unfortunately, the weight loss achieved with lifestyle modifications was not durable. Rather, medications reinforce lifestyle management and play a useful role in long-term management of obesity. Also in this issue: Obesity Approval of the first AOM, desoxyephedrine, in 1947 led to the development of a number of amphetamine derivatives for weight loss that have all since been removed from the market due to this amendment (34). The associations between obesity, central obesity (increased waist circumference, especially intra-abdominal/visceral fat) and the risks for cardiometabolic diseases as well as obstructive sleep apnea, asthma, and nonalcoholic fatty liver disease (NAFLD) are well established (8,9). Obesity is a major risk factor in the development of cardiovascular disease (CVD), type 2 diabetes (T2D), musculoskeletal disorders, and several cancers (2). There is no subsidy for drugs that are approved for weight loss in Australia. Compared to switching to placebo after 20 weeks, continued treatment with semaglutide can sustain weight loss.7 Several drugs do not have an approved indication in Australia for weight loss. For patients with T2DM, cardiovascular disease, knee osteoarthritis, OSA or MAFLD, incretin-based therapies (GLP1-RA or dual GLP1-RA/GIP) should be considered first line because of the significant improvements in obesity-related complications (eg OSA, heart failure with preserved ejection fraction, MAFLD, T2DM) with these drugs. You can calculate your BMI to learn if you are overweight, have obesity, or have severe obesity, which may increase your risk of health problems. Phentermine-topiramate is a combination of a weight-loss drug called phentermine and an anticonvulsant called topiramate. Most prescription weight-loss drugs work by making you feel less hungry or fuller. “To achieve sustainable weight loss, it’s important to take a comprehensive, multi-faceted approach that includes a balanced diet, regular exercise and lifestyle modification.” Avoiding processed foods that are calorie-dense but nutrient deficient and healthy lifestyle choices are essential to achieve a healthy weight,” says Dr. Khaitan. Significant weight loss is never easy and there is no such thing as a magic bullet for weight loss. Talk to your doctor about how to safely taper off the medication and strategies to prevent weight gain. Naltrexone ER/bupropion ER should be used with caution in older patients and is not recommended for those older than 75 years. Moreover, all COR clinical trials showed improvements in cardiometabolic parameters, including glycemic control, insulin resistance, and lipid profiles 28–32. Naltrexone ER/bupropion ER also resulted in significantly greater glycosylated hemoglobin (HbA1c) reduction (−0.6% vs. −0.1%) than the placebo . In this study, all participants were instructed to have a balanced diet of conventional foods and individual goals for energy intake were based on initial weight. A. Pawlowski is a TODAY health reporter focusing on health news and features. The candidates being investigated include MariTide, a drug from Amgen that targets GLP-1 and GIP hormones and is “administered monthly or less frequently,” the company says. "A lot of people are going to like that," Levy says. People trying to lose weight may opt for long-acting monthly shots instead of weekly injections in the future. “At least 25% of the patients I see don't want anything to do with needles,” she notes. In animal studies, peripheral administration of liraglutide results in uptake in specific brain regions regulating appetite, including the hypothalamus and brainstem (71). The FDA recommends monitoring patients for worsening or emergence of suicidal thoughts or behaviors. Bupropion/naltrexone should be avoided in patients with uncontrolled hypertension, history of seizures, history of bulimia or anorexia nervosa, and in individuals taking narcotics for pain control (69). For example, after 20 weeks, cagrilintide 2.4 mg co-administered with semaglutide 2.4 mg resulted in a body weight reduction of 17%; when semaglutide 2.4 mg was co-administered with placebo, body weight reduction was 10% (Enebo et al., 2021). A phase 2 clinical study reported that HRS9531 given at a dose of 6 mg resulted in a 16.8% reduction in body weight from baseline at 24 weeks compared to 0.1% reduction in the placebo group. A preclinical study reported that ecnoglutide reduced blood glucose and body weight and increased insulin secretion significantly more than semaglutide (Guo et al., 2023). Phase 2 studies have used four different doses of orforglipron (12, 24, 36, and 45 mg); at week 26, the mean weight loss from baseline ranged from 8.6% to 12.6% across the orforglipron dose cohorts compared to 2.0% weight loss in the placebo group. Despite the high efficacy of GLP-1-based anti-obesity medications, the need for regular injections is still a significant barrier for many patients. The problems started in the 1930s, when 2,4-dinitrophenol (DNP) became one of the first chemicals used for weight loss. From its earliest days, products have been marred by side effects ranging from high blood pressure to death. The history of weight-loss drug development is a tumultuous one. Ragen Chastain, a public speaker and writer on the subjects of fat discrimination and the pathologizing of weight, says fat is a normal state of being and that calling it a disease is stigmatizing. A 2016 study from the University of California, Los Angeles, suggests that 29% of people who are medically defined as obese are otherwise metabolically healthy. Bupropion is a norepinephrine and dopamine reuptake inhibitor that is used for depression and smoking cessation treatment. In patients with chronic malabsorption syndrome or cholestasis, as orlistat can reduce the absorption of fat-soluble vitamins (i.e., vitamins A, D, E, and K), multivitamin supplementation might be needed. Constipation can be treated by orlistat, along with dietary fiber supplementation, via its gastrointestinal side effects. The side effects experienced by more than 20% of participants who use orlistat for 2 years include fecal incontinence, oily spotting, and fatty stool. She agrees that weight is not a good proxy for health and is frustrated by the number of researchers and doctors who tell their patients that losing weight will alleviate other metabolic diseases. “The fact that people who are higher weight get a health issue more often cannot be led to say, ‘Well, then their body size is the problem and then making them thin will solve the problem,’ ” she says. Lutz Jermutus, who leads the team at AstraZeneca focused on metabolic diseases, downplays that effect and says the company isn’t looking to turn the drug toward weight loss right away. AstraZeneca is also developing a dual-agonist drug for diabetes that industry experts are watching because studies suggest it, too, spurs weight loss. By minimizing damage to organs from conditions like high blood pressure and diabetes, the body has a much greater chance to recover than it would after decades of trying other strategies. The American Academy of Pediatrics’ guidelines call obesity and overweight “one of the most common pediatric chronic diseases in the U.S.,” affecting some 14.4 million children and adolescents. You have two-thirds of the population overweight or with obesity and eligible to take this drug class, at somewhere around $10,000 to $15,000 a year for life.” Emerging drug therapies in obesity This increases the risk of other diseases, including hypertension (high blood pressure), diabetes and high cholesterol. He said the "clearest path forward" for U.S.-based obesity biotechs is likely inking partnerships with larger firms to develop and commercialize their drugs. Some analysts argue that their experimental drugs, most of which are still in mid-stage development, have not differentiated themselves enough from existing treatments. But patients experienced a high rate of side effects and discontinuations in the trial. Hyperlipidemia Overview and the Clinical and Economic Burden Additional phase 3 trials are expected to be completed in 2026, according to the company. The most common side effects were nausea, diarrhea, constipation and vomiting. Wegovy mimics one gut hormone the body produces after eating, GLP-1; and Zepbound mimics two, GLP-1 and GIP. The most common side effects were nausea and fatigue. Bimagrumab is a first-in-class novel AOM that is a monoclonal antibody against activin type 2 receptors on skeletal myoblasts; its phase 2 trial focused on the unique endpoint of fat mass loss rather than total body weight loss (167). Whenever possible, the clinician should consider alternatives to medications known to cause weight gain (163), or should consider measures that would ameliorate the weight-gaining effect of the prescribed drug. When evaluating a patient with obesity for the first time, the clinician should perform a thorough review of all current prescription and over-the-counter medications to investigate for potential weight-gaining medications. Zonisamide (trade name Zonegran) is another antiepileptic medication that has also been found to reduce body weight in patients. †Range of weight loss observed in single-arm trial (not placebo-controlled) depended on genetic mutation. Learn about other weight loss medications that are available The degree of weight loss achieved with surgery is usually much greater and lasts longer than with medications. Achieving sufficient weight loss to reduce obesity-related diseases requires a variety of interventions, including comprehensive lifestyle modification of diet and exercise, change in behavior, anti-obesity medications, and surgery.Furthermore, pharmacogenetic and mechanistic studies to confirm the effects of drugs on feeding behavior and reward processing would allow the further characterization of good responders to various anti-obesity drugs .If you have followed the diet and exercise plan and have not lost at least 5% of your initial body weight within a few months, continuing the drug may be of little benefit.There is a plethora of non-prescription weight loss supplements and herbal medicines available for sale in pharmacies and supermarkets in Australia, and sales suggest that they are widely consumed.Ozempic can help people lose weight, which can reduce the risk for many other serious health conditions, such as heart problems.These treatments work best when combined with nutrition, exercise, and behavioural support.Explore diabetes symptoms, diagnosis, treatments and moreGelesis100 (Plenity) is the first anti-obesity agent that is FDA-approved for adults with overweight (BMI kg/m2) irrespective of comorbidities. It’s important to note that weight is likely to be regained once medications are stopped. Successful weight loss seems to improve almost all biomarkers of obesity comorbidities. As for pharmacological aids, obese patients with type 2 diabetes or insulin resistance seem to benefit from LC diet combined with a GLP-1 agonist, e.g. semaglutide, which may improve glycemic control, stimulate satiety, and suppress appetite. Lifestyle modifications with and without weight loss in hypertension One other difference is that Ozempic is typically covered by health insurance, while Wegovy is often not covered. They both contain the same active ingredient semaglutide. Research has shown that if you stop taking Ozempic (or Wegovy), it's likely that you will gain back the weight you lost. Losing 5% or more of the pre-treatment body weight within one year is also considered successful. Research shows that up to half of people who take weight-loss medicines quit because of side effects.footnote 2 The emerging generation of phase 3 anti-obesity pharmacotherapies demonstrates substantially greater weight loss efficacy than earlier agents currently available in clinical practice. Additionally, a meta-analysis of 30 studies reported that 21% more participants who use orlistat for 1 year achieve at least 5% or greater weight loss, and 12% more participants achieve a weight loss of 10% or more, than those who use a placebo . The proposed algorithm for the management of obesity with available long-term anti-obesity drugs is summarized in Fig. The FDA also requires an anti-obesity drug to improve cardiometabolic parameters, including glycemic control, blood pressure, and lipid levels 12,13. Lifestyle and behavioral modifications are the cornerstones of obesity management but pharmacological therapy should be promptly considered for those who do not respond to lifestyle modifications or experience difficulty maintaining the initial weight loss caused by lifestyle modifications. Obesity, which refers to the state of excessive body fat accumulation owing to an imbalance between energy intake and expenditure, is a major risk factor for non-communicable diseases, such as type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases, and some cancers 1,2. “No medication or supplement can counteract the effects of a bad diet.” Regular exercise, good hydration, and quality sleep are other habits crucial for overall health and better weight loss results. But the FDA has approved the same drug as an overweight and obesity treatment under the name Wegovy. Ozempic and similar drugs have several functions that make them helpful for managing diabetes and weight loss. That means it is absorbed more easily in the body and doesn't require dietary restrictions like Rybelsus does. Eli Lilly is currently about three years ahead of other drugmakers developing pills, including Pfizer, AstraZeneca, Roche, Structure Therapeutics and Viking Therapeutics, Guggenheim analyst Seamus Fernandez told CNBC. The pill could also help Eli Lilly solidify its dominance in the growing segment as a slate of other drugmakers race to bring a product to the market. Fixed-dose combinations of phentermine/topiramate are approved in the US to treat obesity. Thorough knowledge of side effects, precautions and contraindications of these medications is essential and we caution against their prescription by practitioners without expertise in obesity management. Phentermine has been the most commonly used weight-loss management medication in Australia and the US for decades.12 Historically, it has been approved as a short-term therapy, but for treating obesity, a chronic condition, this is illogical. Given the effects of phentermine on the cardiovascular system, it should not be used in patients with a history of cardiovascular disease. Naturally, all medications have their risks and side effects and, as clinicians, we are always weighing the risks and benefits of therapy with the risks and severity of the disease. So yes, while the drugs are incredibly helpful for many people, they are not for everyone.Levy calls the notion of people buying unapproved weight-loss drugs “scary.”You may take weight loss medication as an injection.“These metabolic changes can make it considerably more difficult to lose weight and keep it off.”Over 40% of participants taking phentermine-topiramate achieved 5% weight loss over 20 weeks .But more options are needed, Levy notes, especially since the drugs need to be taken for the long term.Neither SGLT2 nor GLP-1 drugs showed a significant reduction in the risk of vascular dementia or Alzheimer’s disease.Lorcaserin, a selective 5-hydroxytryptamine (5-HT) 2C receptor agonist, suppresses appetite, with expected weight loss of 3.6% at one year.26 Common side effects include upper respiratory tract infections, headache, dizziness, nasopharyngitis and nausea. All prescribers should warn their patients about this, then, by mutual agreement, start one drug and be prepared to change to another if the first drug is not tolerated or is ineffective. A dose that works well with no adverse effects for one individual could cause very severe and intolerable adverse effects in another. For example, drugs may not be needed in ketogenic diets because ketones suppress hunger. Injectable medications (usually once a week) such as semaglutide or tirzepatide are weekly injections that have been proved to be clinically effective. These medications help your body to signal fullness and help reduce hunger. Who is weight loss medication suitable for? NICE and MHRA approved medications Although the field of anti-obesity drug therapy has evolved, there are currently no recommendations regarding the type or class of patients for which anti-obesity drugs are more effective in terms of good responders and poor responders; thus, progress remains to be made in personalized medicine in this field. The weight reduction was 2.2 kg in the placebo group, which indicates that tesofensine might have twice the weight reduction effect of previously developed drugs . In a recent phase 3 trial, setmelanotide treatment led to a significant reduction in body weight and hunger after 1 year of treatment in individuals with Bardet-Biedl syndrome . By Joan Tupponce Turn on the television any time of the day or night and within minutes you'll probably see a catchy commercial for an injectable weight loss drug. Moreover, having clear guidelines would likely help ensure insurance coverage of those medications when obesity is the sole indication. For those who can tolerate semaglutide, it can be added to behavioral therapy and diet modification for achieving and maintaining significant weight loss in the obese/overweight population. Semaglutide is a long-acting GLP-1 receptor agonist that is administered subcutaneously once weekly for the management of diabetes mellitus and has been shown to also induce weight loss . At the one-year point, excess weight loss compared with placebo was 5.3 kg (95% CrI -6.06 to -4.52 kg). These medications are highly effective at decreasing appetite and resetting the patient's set point, the weight a body defends. Previously, with 5% to 10% weight loss, you could improve glucose control, blood pressure, fatty liver disease, and cholesterol numbers. Patients on these novel medications can achieve a 15% to 25% weight loss compared to 5% to 10% with first-generation oral medications. In March 2024, the Centers for Medicare and Medicaid Services issued new guidance saying Medicare Part D plans can start covering anti-obesity drugs if they are also approved for an added health benefit, such as heart health. For example, semaglutide is an expensive drug that is not necessarily covered by insurance or weight loss at this point, says Dr. Jastreboff’s study participant from the tirzepatide trial. Anti-obesity medications work in the brain to help bring that set point down, enabling individuals not only to lose weight but also to maintain the weight loss. Five drugs—orlistat, lorcaserin, liraglutide,phentermine/topiramate, and naltrexone/bupropion—are currentlyapproved for weight loss therapy in the United States.Studies have shown it to be significantly more effective for achieving and maintaining weight loss than placebo and liraglutide.Can men and women use the same medications?The company also launched a temporary introductory offer, which will allow new cash-paying patients to access the two lowest doses of Wegovy and Ozempic for $199 per month for the first two months of treatment.He or she will watch to see if your weight loss improves your type 2 diabetes, cholesterol, and blood pressure.Among the pharmaceutical interventions currently approved for long-termweight management, the combination drug therapy of naltrexone/bupropion is theonly one that raises blood pressure.This article summarizes existing and emerging anti-obesity medications, with a particular focus on those evaluated in clinical trials. The active ingredient in Ozempic, semaglutide, does work for weight loss, according to research. When using Ozempic to treat diabetes, weight loss is a common side effect. It is not approved for weight loss, but some physicians prescribe it to be used for weight loss. Do health experts recommend Ozempic for weight loss purposes? GLP-1 drugs mimic a hormone the body produces after eating, which can decrease appetite. Sleep disorders have been reported in a significant number of patients taking naltrexone ER/bupropion ER; thus, the deterioration of existing sleep disorders or development of newonset sleep disorders should be monitored when the drug is administered. As phentermine/topiramate CR can cause mood disorders, it should be avoided in patients with mood disorders. However, because there is less interaction with antidepressants, liraglutide should be considered first for patients taking antidepressants. SACRAMENTO, Calif. — Many low-income Californians prescribed wildly popular weight loss drugs lost their coverage for the medications at the start of the new year. Researchers are working to identify safer and more effective medications to help people who are overweight or have obesity lose weight and maintain a healthy weight for a long time. When combined with lifestyle and behavior changes, including healthy eating and increased physical activity, prescription medications help some people lose weight and maintain weight loss. ILI consisted of a 7% weight loss goal, 150 minutes per week of physical activity, and a low-fat diet. While the mean weight loss seen with bupropion is small, it is a preferred alternative to most antidepressants, which commonly cause weight gain. Bupropion (trade name Wellbutrin or Zyban) is used for depression and smoking cessation and can cause weight loss as a side effect. Topiramate is a gamma-aminobutyric acid agonist, glutamate antagonist, and carbonic anhydrase inhibitor; it is a drug used for epilepsy treatment and migraine prophylaxis (Pilitsi et al., 2019). Naltrexone (NAL) is an opioid receptor antagonist approved as a treatment for opioid dependency and alcohol dependence. Orlistat was approved for long-term weight management by the Food and Drug Administration (FDA) in 1999 and the Korea Ministry of Food and Drug Safety in 2000 (Jeon et al., 2023). Short-term treatment options include phentermine, diethylpropion, phendimetrazine, and mazindol (Jeon et al., 2023). Therefore, guidelines recommend that obese individuals lose 5% to 10% of their initial body weight within 6 months of starting a weight-loss intervention (Kim et al., 2023). CagriSema is a combination treatment that combines 2 injectable medications (cagrilintide and semaglutide) into 1. There are also new incretin medications being developed that target more than one receptor, both to treat diabetes and obesity, including one called tirzepatide. That’s why the most prescribed obesity medication is phentermine, which is a generic medication that’s only approved for short-term use and has not been tested in long-term studies. Most people taking anti-obesity medications pay for them out of pocket, and they can be very expensive. Results from a follow-up study of semaglutide versus placebo showed that this weight loss can be sustained for at least two years. They are not recommended for children, women who are pregnant or breastfeeding and those with certain health conditions like liver or kidney problems. Some also report side effects like irritability, anxiety and/or sleep problems. Glucagon-like peptide-1 (GLP-1) is a naturally occurring hormone that is released by the intestines after eating and stimulates the pancreas to produce insulin, which lowers blood sugar levels. “These metabolic changes can make it considerably more difficult to lose weight and keep it off.” SGLT-2 inhibitors aren't recommended for people who have had diabetic ketoacidosis.Semaglutide 2.4 mg in combination with cagrilintide, an amylin analog, has been shown to cause 15% weight loss in a phase 2 trial (165).Nedelcovych likened shutting them down to "a case of whack-a-mole." Eli Lilly and Novo Nordisk's lawsuits against telehealth companies, pharmacies and others since 2023 have consumed time and resources, with mixed legal outcomes.It’s important to note, not everything on kffhealthnews.org is available for republishing.Liraglutide was recently approved in Australia for weight management as an adjunct to diet and physical activity.The reported adverse reactions related to setmelanotide treatment are injection site reactions, nausea, vomiting, and hyperpigmentation.Many people don't have side effects.The two drugs are essentially the same ingredient – and just have different dosages. Lorcaserin, a selective 5-hydroxytryptamine (5-HT) 2C receptor agonist, suppresses appetite, with expected weight loss of 3.6% at one year.26 Common side effects include upper respiratory tract infections, headache, dizziness, nasopharyngitis and nausea. The combination of an opioid antagonist (naltrexone) and a dopamine and noradrenaline re-uptake inhibitor (bupropion) has been shown to provide average weight loss of 4.8% after one year.25 Common side effects include nausea, vomiting, headache, dizziness and dry mouth. Off-label pharmacotherapy (not approved by Therapeutic Goods Administration for weight loss) A 2024 health tracking poll by KFF found that around 1 in 8 US adults said they had taken one. GLP-1 agonists like Wegovy, Ozempic, and Mounjaro might benefit heart and brain health—but research suggests they might also cause pregnancy complications and harm some users. Before he became editor of Discover in 2012, Steve George spent more than 20 years as a writer and editor, specializing in health and medicine. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. Can men and women use the same medications? All GLP-1 and dual-agonist medications are prescription-only in the UK. Do I need a prescription for weight-loss medication? It was created by conjugating a fully human monoclonal anti-human GIPR-antibody with two GLP-1 analog agonist peptides using amino acid linkers. Heart rate increased dose-dependently up to 24 weeks and reduced thereafter (Jastreboff et al., 2023). All mazdutide doses were well tolerated; the most common adverse events were diarrhea, nausea, and upper respiratory tract infection. People with a body mass index above 30 kg/m2 have obesity.Your body may not absorb important vitamins, minerals, and other nutrients from food while you are using orlistat.Most gastrointestinal symptoms are mild to moderate, transient and diminish within days or weeks with continued treatment.Is Alli — an over-the-counter weight-loss pill — the solution to your weight-loss woes?Recent studies show that newer Western pharmaceuticals and some traditional Chinese medications may be effective for appropriate patients in need of weight loss.Antiobesitydrug therapy may also be helpful for maintenance of initial weight loss achievedwith diet and exercise . Treatment guidelines recommend consideration of additional therapies such as pharmacotherapy and bariatric surgery when lifestyle intervention has not resulted in sufficient weight loss to improve health or quality of life. But people who take them still have better weight loss results than those who do not take the medicine. In general, studies have found that tirzepatide and semaglutide are the most effective for weight loss. But the amount of weight loss depends on the type of medicine and the dose. It's also used to control blood sugar and can support weight loss. How to Stay Safe Against GLP-1 and Weight-Loss Scams Indeed, these medications are helping people lose a lot of weight. New prescription weight loss drugs like Ozempic, Wegovy and Zepbound are currently in the spotlight for their fast, dramatic results. In a mid-stage study, patients with obesity taking MariTide lost up to 16.2% of their weight in one year when analyzing all participants regardless of discontinuations, or up to 19.9% when only analyzing those who stayed on the treatment. Semaglutide treatments can also be used as an alternative to bariatric surgery for some patients who are obese. It's the first drug approved for this purpose since 2014. Wegovy is a once-weekly injection approved by the FDA in 2021 for chronic weight management. Ozempic has a smaller dose of semaglutide than Wegovy. Ozempic, known generically as semaglutide, was approved in 2017 by the U.S. The STEP 6 (Kadowaki et al., 2022) and STEP 7 trials (Mu et al., 2024) were conducted in Asian populations and included people with T2DM; they demonstrated a mean weight loss of 13.2% and 12.1% in semaglutide and 2.1% and 3.6% in placebo, respectively. The results demonstrated significant body weight reductions in individuals taking liraglutide at a dose of 3 mg compared with those taking the placebo (8.0% vs. 2.6%); in addition, more people in the liraglutide group achieved a ≥5% reduction in body weight than in the placebo group (63.2% vs. 27.1%). However, evidence suggests that short-term treatment (3 to 6 months) with weight-loss medications does not produce long-term health benefits (Garvey et al., 2016); therefore, this review focuses on long-term weight-loss anti-obesity medications. Currently available long-term anti-obesity medications for adults include orlistat, naltrexone/bupropion (NAL/BUP) extended release (ER), liraglutide, phentermine/topiramate ER, semaglutide, and tirzepatide (Table 1). The weight-loss results in patients prescribed GLP-1 receptor agonists to treat diabetes inspired research to see whether higher dosages would produce even more weight loss. In addition, semaglutide and another medication in this class, liraglutide, reduce risk of major adverse cardiovascular events with diabetes. At the dosage approved for diabetes, GLP-1 receptor agonists not only lower blood glucose, but also reduce weight by about 3-5% of initial weight. According to the Government Accountability Office, only about 660,000 of more than 70 million Americans with obesity used prescription weight-loss medications from 2012 through 2016. We also know from studies that the use of anti-obesity medications can also reduce the risk of prediabetes progressing to diabetes. For example, it can be be used with healthy eating, physical activity and behavior change. So some healthcare professionals might order it for longer use. Phentermine is approved for use for up to 12 weeks. As an increase in blood pressure is observed at high doses, it is important to demonstrate the safety of tesofensine in a large-scale clinical trial. In a small-scale clinical trial with 161 participants, people who received either 0.5 or 1.0 mg of tesofensine for 24 weeks experienced weight reductions of 11.3 and 12.8 kg, respectively. As weight reduction was reported as a side effect, clinical trials on obesity were conducted, and tesofensine was observed to decrease the desire for food, food consumption, and weight . Topiramate can be started at a dose of 12.5 mg once daily and up-titrated to 50 mg twice daily. Gastrointestinal side effects are the main reason for discontinuation of therapy. Side effects are related to fat malabsorption and include oily stool leakage, steatorrhoea and fat-soluble vitamin deficiencies. The recommended dose of orlistat is 120 mg three times daily (tds) with a fat-containing meal. Orlistat is a potent inhibitor of gastric and pancreatic lipase resulting in reduced fat absorption and loss of weight. Alli (pronounced AL-eye) is an over-the-counter drug meant for overweight adults struggling to shed excess pounds. Most weight-loss medicines have side effects like nausea, vomiting, headaches, and constipation. Many people regain the weight they lost after they quit taking the medicines. Speak with your health care provider if you are concerned that your weight is affecting your health. But others raise questions about how much of a role pills will play in the space given that some appear to be less effective than injections and bring greater side effects. If that study shows that GLP-1s reduce the risk of cognitive decline, "it would give a big boost" to Novo Nordisk and Eli Lilly because it could encourage patients to stay on them longer, said Leerink Partners analyst David Risinger. In 2025, weight-loss GLP-1s accounted for an average of 10.5% of total annual claims among employers, up from 8.9% in 2024 and 6.9% in 2023, IFEBP found. Limited insurance coverage for GLP-1s is blocking out patients who can't afford their roughly $1,000 monthly price tags. Keep in mind that the key to losing weight is a whole lifestyle approach that involves eating well and moving more. Learn all you can about any weight-loss supplement you think about trying. Some weight-loss supplements have been found to have ingredients that aren't listed on the label, such as prescription medicines. Results from such a trial would show more about the product safety and how well it worked. It would be ideal if these first results had been tested in a much longer trial. Sam's Club, Costco Selling Discounted Weight Loss Drugs Without Insurance. How Much Will They Cost? If you aren’t losing weight, they may increase the dose. The U.S. Food and Drug Administration (FDA) has guidelines for who is eligible for drugs like Wegovy. Over time, you can lose 10-20% of your body weight. And a short trial like this may miss side effects that only show up with long-term use. The trial included 70 adults with obesity. The promise of fast and easy weight loss is hard to resist. Check out our Living Light Living Well classes for weight loss support But those results come with the caveat that participants were taking semaglutide doses for diabetes, not the much higher dose prescribed for weight loss. At the end of the study, nearly 35% of the 1,059 people who completed the trial lost at least 20% of their body weight—a level no other weight-loss drug has achieved. Older weight-loss drugs not only were prone to dangerous side effects but also didn’t work as well as people wanted. A narrative review of RCT and real-world data found no compelling link between semaglutide and thyroid cancer (103), and a systematic review and meta-analysis further concluded there was no increased risk of any cancer with semaglutide (104). In rodents, semaglutide was found to cause thyroid C-cell tumors, but no human cases have been linked to semaglutide use. The improvement in HFpEF symptoms may be mediated by weight-independent mechanisms and measurable via reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP)(101). Direct head-to-head data versus oral semaglutide 50 mg is not yet available. Unlike semaglutide, orforglipron is a small-molecule compound and can be easier to absorb through the stomach lining, allowing for less restriction with food timing. In addition, she conducts intramural clinical research on obesity in the section on Growth and Obesity at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This difference is likely, at least in part, due tosubstantially greater weight loss observed individuals who underwent bariatricsurgery compared to lifestyle modifications (mean 21.8% vs. 9.6% at fiveyears). The mechanisms driving altered medication handling in the settingof excess adipose tissue include expanded volume of distribution, alteredhepatic metabolism (due to nonalcoholic fatty liver disease) , renal hyperfiltration (or alternatively,impaired renal clearance due to chronic kidney disease) 18, 19, andincreased sympathetic activity 23, 24. Excess adipose tissuealso alters the pharmacokinetic and pharmacodynamic handling of manymedications. Taking into account the pathophysiologic drivers of elevated bloodpressure due to adipose tissue, individuals with obesity experience severalchallenges in the management of their hypertension (Table 1). One trial showed an average 12 percent weight loss among patients with Type 2 diabetes after a year.But not everyone is eligible for treatment with semaglutide.Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions.Josua Jordi, CEO of the start-up EraCal Therapeutics, which is focusing on weight-loss drugs, calls these risks the “dark cloud” of DNP.Obesity is a major risk factor in the development of cardiovascular disease (CVD), type 2 diabetes (T2D), musculoskeletal disorders, and several cancers (2).“It creates a lot of demand, and it creates openings for people to exploit that demand,” Jay tells TODAY.com.Learn why you should partner with a provider for your healthBefore using a medication, learn all you need to know about it.The assistant professor of medicine (general medicine) at Yale School of Medicine is interested in helping prevent chronic disease. If it enters the market, orforglipron could help more patients access the treatments and alleviate the supply shortfalls of the injections on the market. Eli Lilly plans to release initial results from several late-stage clinical trials on its experimental once-daily obesity pill, orforglipron, this year. These low prescription rates and prescription differences are concerning because of the benefits these drugs could provide for millions of Americans. “Some of these minority populations bear the biggest burden of obesity,” says Lu, who is also an assistant professor of biomedical informatics and data science at YSM and of chronic disease epidemiology at Yale School of Public Health. Side Effects of Weight Loss Medications Bariatric surgery is very effective for weight loss and reversal of type 2 diabetes mellitus (T2DM), but it is invasive and not consistently durable in all patients. Here we review the pharmacology, benefits, and risks of Western and Chinese medications used for weight loss. Regardless of how much weight they lose on these medications, patients feel more in control of their relationship with food because the brain’s food reward mechanisms quiet down.