On occasion, we have patients who need weight management consulting. I’m less worried about someone who is overweight and only worried about obesity when there are major health risks. So when is it time for weight loss medication? Often, when traditional weight loss methods fail.
Weight Loss Medication Options
Though the media advertises GLP1 medications like simaglutide, there are lots of other effective and safe weight loss medications to choose from. The choice comes down to the individual. Some people have a food-eating disorder, others have a slower metabolism, and yet others can’t get easily satiated.
Regardless of which medication we use, it’s always temporary, and it’s always done under the guidance of a specialist with expertise in using weight loss medication.
Common medications used are:
Long-Term Use of Medications
Most of these medications are quite effective at lower dosages and tend to have the most side effects when used in larger doses. The goal is to use them for the shortest time period, along with effective lifestyle strategies.
Most of my patients who have been on long-term weight loss medication have developed some sort of tolerance; the medication basically stopped working after a few months.
The longer we can maintain someone’s ideal weight off of medications, the more likely it is that medications can still be effective if the weight comes back on. I’ve had patients over the years who’ve needed a few cycles of weight loss medication.
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Meds or No Meds
It’s not a question of meds or no meds when it comes to weight loss. Public discussions make it seem as though there is a right answer for everyone. Even when it comes to treating an acute heart attack, there is no one-size-fits-all solution; each patient has to be evaluated and treated individually. Weight loss management is no different.
If a blanket statement is in order, then no medication is better than medication. If that isn’t satisfactory, it’s likely because the situation is genuinely nuanced, which makes it so interesting and worth living.
If medication is needed, then the risks of treatment have to be weighed against not treating. Sometimes, the emotional toll of having a larger waist size is too much to bear, and medications make sense. In other cases, the medications are too harmful to justify their use.
Choosing a Weight Loss Medication
I refer my patients to an obesity expert for management even if I can manage my patient’s medication. The reason is that it’s an art and what you read online isn’t what’s supported by good quality research.
For example, we still start many patients on phentermine as a first line and often topiramate. This isn’t sexy because these are unbelievably cheap, generic medications readily available. When the goal isn’t met and the patient is the right fit, we’ve seen great results with naltrexone.
It’s important to highlight that when the media heavily pushes a new medication, the manufacturers will fund researchers and authors also to discredit older medications such as phentermine. A good physician can help you ignore the noise and focus on what is the best option for you as an individual.