Weight loss interventions that work
If changing your diet and exercise habits has failed to help you achieve the results you hoped for, weight loss medication can be an option.
However, it is important to seek out a physician who is board-certified in obesity medicine who can help select the appropriate drug based on your medical history. Only a professional can responsibly help you manage the risks and benefits of different drugs, according to Sue Cummings, a registered dietitian who was clinical programs coordinator at the Massachusetts General Hospital Weight Center for the past 20 years.
Weight loss medications are typically indicated for those with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with health conditions such as high blood pressure or type 2 diabetes. A person who is 5 feet 8 inches tall and weighs 200 pounds has a BMI of 30.4; online tools can help you calculate your BMI. Though there are exceptions, “in general, that’s where we start treating people,” said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian. Drugs are typically prescribed along with diet and physical activity changes.
Since there is a broad range of medications available, finding one that will work is almost always possible, according to Aronne, who co-authored the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.
Identifying the right match is key, as a drug may or may not be appropriate for someone depending on their health history. For example, if someone has uncontrolled high blood pressure, you wouldn’t prescribe phentermine (a weight loss drug approved for short-term use), Aronne explained. In order for a weight loss drug to be approved for long-term use, it must have two years of data showing that it is safe and it works.
In general, a medication can be considered effective for weight management if, after one year of treatment, at least 35% of those in the drug group (and about double the proportion of people of the placebo group) lose at least 5% of their weight.
Weight loss drugs approved for long-term use include orlistat (brand name Xenical), lorcaserin (Belviq) and liraglutide (Saxenda) as well as the combination drugs naltrexone-bupropion (Contrave) and phentermine-topiramate (Qsymia).In one recent study, these drugs helped overweight or obese people lose at least 5% of their body weight at the end of a year — that’s at least 10 pounds if you weigh 200 — compared with a placebo. Qsymia and Saxenda were associated with the highest odds of achieving that amount of weight loss.
Losing 5% to 10% of your body weight is associated with improved blood pressure, triglycerides and blood sugar, factors that lower the risk for heart disease and diabetes.