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Weight Loss and Control (cont.)

Medications and Surgery for Obesity

For people who are overweight and have been unable to lose weight with diet and exercise, consulting a weight-loss clinic may help. There are several prescription diet pills that are now available.

  • Sibutramine (Meridia) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in 1996. It may be recommended for people who are more than 30 pounds overweight. In clinical trials, people who took this drug lost an average of 5%-10% of their body weight. It may also help to keep weight off. It works by making the person feel full and thereby decreases food intake. It may cause an increase in blood pressure and should not be used by people who are on a number of other medications, such as antidepressants.
  • Orlistat (Xenical 120 mg by prescription or Alli 60 mg available over the counter) is a medication approved by the FDA in 1999. Your doctor may prescribe it if you weigh more than 30% over your healthy body weight or have a BMI greater than 30. Over one year, people who followed a weight-loss diet and took orlistat lost an average of 13.4 pounds, almost 8 pounds more than people who used diet alone to lose weight. It works by reducing the absorption of fat from the intestine. Diarrhea and incontinence of stool may be side effects of this medicine.
  • Lorcaserin (Belviq 10 mg one to two times daily) was just approved by the FDA in June 2012. It may be considered if your BMI is 30 or greater or if you have a BMI greater than 27 with weight-related conditions. Studies demonstrated that almost half of patients lost an average of 5% of their body weight when combined with diet and exercise (compared to 25% of patients with diet and exercise alone). Lorcaserin works by activating the serotonin 2C receptor in the brain, which helps you feel full after smaller portions. The most common side effects were headache, nausea, and dizziness.
  • Qsymia (combination of phentermine and topiramate) was just approved by the FDA in July 2012. It is only approved for those with a BMI greater than 27 with weight-related conditions. When combined with diet and exercise, studies have shown that half of the participants lost 10% of their body weight and four-fifths lost 5% (which equates to 12 pounds in a 227-pound person). Topiramate is associated with a high risk of birth defects such as cleft lip and palate. Phentermine (an appetite suppressant) was one of the ingredients in fen-phen and is associated with an elevation in heart rate. Because of these potentially serious side effects, Qsymia is only available through mail order. Other side effects include tingling, dizziness, alterations in taste, insomnia, dry mouth, and constipation.

Surgery to correct obesity (known as bariatric surgery) is a solution for some obese people who cannot lose weight on their own or have severe obesity-related medical problems. Generally, surgery is recommended only for morbidly obese people (body mass index 40 or greater) or for those with a BMI of 35 and greater or who have weight related-conditions. This generally means men who are at least 100 pounds overweight and women who are at least 80 pounds overweight.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

Allison, D.B., et al. "Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP)." Obesity 20.2 Feb. 2012: 330-342. Epub 2011 Nov3.

Fidler, M.C., et al. "A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: the BLOSSOM trial." J Clin Endocrinol Metab 96.10 Oct. 2011: 3067-3077. Epub 2011 Jul27.

Gadde, K.M., et al. "Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial." Lancet 377.9774 Apr. 16, 2011: 1341-1352. Epub2011 Apr8.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. In: Dietary Guidelines for Americans, 2010. Chapter 3 – Foods and Food Components to Reduce. 7th Edition, Washington, DC: US Government Printing Office; 2010: 30-32. Available at <http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter3.pdf .> Accessed March 8, 2012.


Medically Reviewed by a Doctor on 5/23/2016
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