Weight management and obesity are lifelong struggles for many Americans. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that 1 in 3 American adults are overweight. 2 in 5 American adults (42.4%) have obesity. 1 in 6 children is overweight, and 1 in 5 have obesity. Obesity and excess weight are associated with serious health problems, such as type 2 diabetes, high blood pressure, high cholesterol and heart disease.

The risks and complications associated with being overweight or having obesity are well known, but many Americans have a hard time losing enough weight and keeping it off. For those who have persistent difficulty maintaining a healthy weight, the Food and Drug Administration (FDA) has approved several prescription drugs that help with weight loss. In this article, we take a look at these options to help you understand the treatment plans available to you. It’s important to note that all of these FDA-approved drugs are prescribed in conjunction with a healthy diet and increased physical activity. These drugs are only a part of a comprehensive treatment package.

Who is eligible to use weight-loss medication?

Weight-loss medication must be prescribed by a licensed health care provider. These drugs are offered to patients who are at risk for serious health problems caused by excess weight, as well as patients who have obesity and are unable to maintain healthy body weight through lifestyle changes.

The CDC defines obesity as having a body mass index (BMI) over 30. Obesity affects numerous functions in the body. Holding excess fat in the internal organs can cause serious medical problems and adversely impact the quality of life.

Complications that may be caused by obesity include:
- Heart disease
- Strokes
- High blood pressure (hypertension)
- Type 2 diabetes
- Cancer (especially cancers of the internal organs)
- Sleep apnea (potentially life-threatening breathing problems when sleeping)
- Gallbladder disease
- Liver problems
- Osteoarthritis (damage to the joints)
- Gout

Weight loss medication is usually prescribed only after a patient has demonstrated difficulty with losing weight and keeping it off. Before starting treatment with any such drugs, it is important that you have a conversation with your health care provider about common side effects and the pros and cons of this form of treatment. Weight loss medication is prescribed in conjunction with other forms of treatment, such as dietary and physical activity adjustments.

What weight loss medications are FDA-approved?

There are six prescription medications approved for use as a part of a complete weight loss treatment plan by the FDA.

These FDA-approved weight-loss medicines are:

• Orlistat (Xenical): Orlistat belongs to a classification of medications known as lipase inhibitors. Lipase inhibitors help individuals lose weight by preventing the intestines from absorbing fats in their food. Unabsorbed fats are removed from the body via bowel movements. A lower-strength version of Xenical is available over the counter under the brand name Alli.
  
• Phentermine-topiramate (Qsymia): This is a combination of a weight-loss drug (Phentermine) and an anticonvulsant (topiramate). Qsymia works throughout the day to help patients feel full when they eat. It may also change the taste of some foods making them less enjoyable to eat. Bupropion-naltrexone (Contrave): This combination drug works by affecting changes in the hypothalamus, which is part of the brain that controls cravings, appetite, and your body's metabolic functions.
  
• Liraglutide (Saxenda & Victoza): Also used to manage diabetes, liraglutide is generally administered via injection. Similar to a natural hormone in your body (incretin), liraglutide works by controlling your appetite.
  
• Semaglutide (Wegovy & Ozempic): Wegovy is classified as a GLP-1 receptor agonist, a category of antidiabetes medication that acts like incretin hormones (hormones released by the pancreas to stimulate a decrease in blood sugar levels). Incretin hormones also impact how fast food is moving through your gut, so Wegovy can slow down how fast food leaves your stomach when it mimics those hormones. This can decrease appetite and aid in weight loss.
  
• Setmelanotide (Imcivree): Setmelanotide is administered via injection to patients who have obesity due to relatively rare genetic medical conditions. Setmelanotide belongs to a classification of medication known as melanocortin 4 (MC4) receptor agonists. These drugs work by activating certain pathways in the brain, which can reduce appetite and stimulate resting metabolism.
  
  

These drugs vary in their effect on the body. The specific drug prescribed will depend on your condition, your health history and other medications/ supplements you are currently taking.

Do weight loss drugs cause side effects?

If a doctor has prescribed the use of a weight-loss medication, it is because they have deemed that the benefits outweigh the potential side effects. Still, it is important to be aware of the possible risks associated with the medication. Side effects will vary depending on the type of medication and the user, but a broad scope of possible side effects includes nausea, vomiting, constipation, diarrhea, dry mouth, stomach pain, headaches, increased heart rate, trouble sleeping, sweating, and more.

You should tell your doctor about any health conditions you are currently managing before starting treatment with weight loss medicine. Weight loss drugs are generally not recommended for women who are pregnant, are planning to become pregnant, or are currently breastfeeding. Talk to your doctor about any other medications or supplements you are taking before starting treatment with a prescription weight loss drug. Weight loss drugs can interact with other substances in the body causing severe adverse reactions.

How long do I take weight loss drugs?

The prescription drugs listed above are approved for long-term use. After you start taking the medication, the prescribing provider will monitor your progress for several months. If you lose enough weight and do not experience any serious side effects, you may be directed to continue taking the medication.

Research from the NIDDK shows that patients who take prescription weight loss drugs lose about 10% of their initial body weight when combining medicine with a healthy diet and regular exercise. These results vary from person to person. If you have not lost 5% of your body weight after 3-6 months of taking weight loss medication, your doctor may adjust your dosage or prescribe a different form of treatment.

Do I need to exercise while taking weight loss medication?

Weight loss medications are not enough to treat obesity on their own. Health care professionals will prescribe weight loss drugs in conjunction with other therapies such as dietary adjustments and increased physical activity.

The drugs listed above can help your body process certain substances, making it easier to lose weight. Some can reduce cravings or your appetite, which will help you intake fewer calories throughout the day. These actions are supplemental, however, to the sustainable therapies of eating a healthy diet and getting regular exercise. Lifestyle changes help with weight loss goals while also helping to prevent serious health conditions such as high blood pressure, type 2 diabetes, high cholesterol and heart disease. Any prescription drug you are given to help with weight loss should be taken in addition to–not instead of–these healthy practices.

Can I get weight loss medication without seeing a doctor?

The weight loss drugs detailed above are only available via prescription. Lower-strength orlistat–available under the brand name Alli–is available over the counter, but most of these drugs must be ordered by a health care provider. Sesame offers convenient and affordable video weight management visits so you can talk to a licensed provider without having to go to a clinic. During these telehealth visits, you can discuss your condition and possible treatment plans with specialists in weight loss and weight-related health problems.

Providers can prescribe weight loss during these video visits, if appropriate. Depending on the medication, you can have your prescription delivered to your home or ready for same-day pickup at a pharmacy of your choice.