FDA Approved Weight Loss Medications – Do They Work?
The latest numbers show that 73 percent of adults in the U.S. are experiencing overweight or obesity and almost half are trying to lose weight (1,2). Losing weight and keeping it off are no easy tasks. Making healthy lifestyle changes, and maintaining them for weeks, months, and years can be extremely difficult (3).
Choosing more nutritious foods in optimal amounts and increasing physical activity are wise moves for just about everyone’s physical and mental health. Losing 5-10 percent of weight helps to lower triglycerides, blood pressure, and blood sugar levels (4). However, even after implementing a healthier lifestyle, there may be a [need/recommendation] to further reduce weight (3).
The good news is that there are a number of [weight loss/diet][drugs/medications/treatments] approved by the FDA for long-term use. They’re also known as “anti-obesity medications” (AOMs) (5). These medications can provide some extra help. They’re meant to be used [in addition to/alongside] healthy eating habits and regular physical activity because these medications don’t work on their own (3,4,5,6).
Most of these weight loss medications require a prescription from your doctor. They are mainly for people who have already tried to lose weight through diet and nutrition and exercise, and either have a BMI of at least 30, or have a BMI of at least 27 plus a health condition like diabetes or high blood pressure for which there would be a great health benefit to lose additional weight (5,7).
The purpose of these medications is to help manage weight while already eating a nutritious diet and doing regular physical activity (7). Combining one of these medications with a healthy lifestyle will help to boost weight loss by 3-12 percent more than diet and lifestyle changes alone (4,7). They are not recommended for anyone who is pregnant, breastfeeding, or trying to get pregnant (7).
This article briefly discusses some of the pros and cons of taking these medications, such as their benefits, how they work, their side effects, as well as some important nutrition strategies you need to know when taking one of these medications.
What are the weight loss medications and how do they work?
There is a wide selection of long-term weight loss medications to choose from (5). There isn’t one that is going to be the most effective for everybody and it’s not possible to know for sure which would work best for you or how effective it will be (5). Start with a conversation with your doctor to help decide where to start. Based on your current health status, other medications and supplements you’re taking, and your family history, along with how expensive the medications are and their associated side effects, you and your doctor can decide next steps (4,5).
According to the Obesity Medicine Association, “All weight loss medications work best in the context of a healthy eating plan and exercise” (5). There are several different ways that these weight lossmedications work. Most help you to feel less hungry, to feel fuller faster, and/or to reduce cravings (5,7). They do this by interacting with hormones (e.g., leptin, ghrelin), neurotransmitters (e.g., GABA, serotonin), and peptides (e.g., GLP-1) found in the brain, digestive system, and fat tissue (5,6).
This physiological strategy works because when you feel less hungry, fuller faster, and have fewer cravings, it becomes easier to consume fewer calories, resulting in weight loss (6).
Orlistat works differently because it impacts the way the digestive system absorbs fat (7).
Semaglutide, tirzepatide, and liraglutide
Semaglutide and tirzepatide are weekly injections of “glucagon-like peptide-1 (GLP-1) and GIP receptor agonists” (4,5). They work by targeting areas of the brain that regulate appetite and food intake (4,5). The dosages start low and are gradually increased over the course of 16-20 weeks (5). The reason for starting with a lower dosage is to reduce side effects (e.g., digestive issues, headaches, dizziness, and fatigue) (5).
Liraglutide is a daily injection that acts on gut hormones to help feel fuller faster and to decrease hunger (5).
Bupropion-naltrexone
These tablets are a combination of two different drugs including an antidepressant that can help weight loss and an opioid receptor antagonist that helps with alcohol and drug dependence (4,5). Taking these together can impact the pleasure-reward area of the brain and help to feel fuller faster and decrease appetite and cravings (4,5).
Phentermine and phentermine-topiramate
Phentermine is the oldest and most commonly used weight loss medications (5). Phentermine is a pill that works by reducing appetite to make you less hungry (4). When combined with topiramate (used to help with seizures and migraines), they work together to further reduce appetite and cravings (5).
Setmelanotide
Setmelanotide is a daily shot that is specifically for people who have a certain rare inherited disease (e.g., Pro-opiomelanocortin deficiency, proprotein subtilisin-kexin type 1 deficiency, or leptin receptor deficiency) (7). While it doesn’t treat the underlying genetic condition, setmelanotide can help with weight loss by helping to feel fuller, reduce appetite, and help the body burn more calories at rest (7).
Orlistat
As mentioned above, Orlistat is different from the rest of the long-term weight lossmedications. It’s available by prescription and a reduced strength version is non-prescription (7). Orlistat capsules are taken with meals and work to reduce the body’s ability to break down and absorb fat from foods and drinks by about 30 percent (8). It does this by preventing the enzymes that digest fat from working (5). This means that, instead of absorbing the calories from fats, they continue traveling through the digestive system and are eventually excreted.
What are some common side effects of weight loss medications?
While these medications seem to be safe for most people, when used as directed, there are some side effects to be aware of (6). Most of the side effects are mild and many resolve with continued use (4). The most common side effects affect the digestive system, such as nausea, constipation, and diarrhea (7,8). Some people may also experience dry mouth, abdominal pain, vomiting, headaches, dizziness, nervousness, insomnia, and tiredness (5,7,8). As with any drug, there is a small chance of serious side effects (7).
With orlistat, the unabsorbed fats going through the digestive tract undigested is why some of the common side effects include abdominal pain, loose stools, and passing more gas (4,7).
Another common experience with anti-obesity medications is regaining some of the lost weight after stopping their use (4,5,7,8). This is the body’s natural metabolic response to weight loss—including weight loss with or without medications (5). This is partly due to a decrease in resting metabolic rate, as well as impacts to the hormones that make you feel hungry and full (5). According to the Mayo Clinic, “practicing healthy lifestyle habits may help limit weight gain” (7).
It’s important to stay in touch with your doctor when taking any anti-obesity medication, and to contact them if you experience any negative effects (6). You may need to follow-up regularly to share how you’re feeling, what side effects you’re experiencing, and how much weight you’ve lost so far (7). These can help you and your [doctor/physician] determine whether the medication is working for you, whether to switch to another one, and when to stop taking it (7).
What nutrition advice is essential when taking weight loss medications?
The most important thing to consider when taking any of these weight loss medications is to maintain a nutritiouseating plan. This means that you’re getting all of the essential nutrients and eating the optimal quantities of food to help you reach your weight loss goals. Avoid weight loss programs that have too many unrealistic promises (1).
According to the National Institute of Diabetes and Digestive and Kidney Diseases, a safe and successful weight loss program includes “a healthy, reduced calorie eating and drinking plan, a plan for increasing physical activity if appropriate, guidance and support for adopting these lifestyle habits, and a plan for keeping the weight off” (1).
The purpose of a good weight loss program is to set realistic weight loss goals, promote healthy long-term behaviors, and provide techniques to track progress and overcome barriers (1). Ideally, all of the elements listed above would be tailored to your specific situation by a healthcare professional such as a registered dietitian.
While there is no one-size-fits-all weight loss program, there are some important nutritional guidelines to keep in mind when working toward losing weight:
A realistic weight loss goal is to lose about one pound per week (9)
Focus on highly nutritious, filling, fiber-rich foods like fruits, vegetables, and whole grains (9)
When it comes to meat and dairy, choose leaner cuts and lower fat options (9)
Minimize less nutritious foods (e.g., fried foods, or those high in sugar or salt) (8,9)
Keep portion sizes in check (8,9)
Choose water as your go-to beverage (9)
Increase the amount of physical activity you do on a regular basis (9)
Because Orlistat works to prevent fat digestion, there are a few additional nutrition recommendations specific to this medication:
Reducing the absorption of fats can also reduce the absorption of some essential vitamins and minerals. Talk to your trusted healthcare provider about including a multivitamin or other supplement (8).
Many of the gastrointestinal side effects can be reduced by pairing orlistat with a diet that’s lower in fat (5).
Final thoughts
According to the Mayo Clinic, “Weight-loss drugs aren't an easy answer to weight loss. But they may help you make the lifestyle changes that you need to practice losing weight and improving your health” (7).
Do you need help making lifestyle changes that can lead to sustainable weight loss with or without [weight loss/diet/anti-obesity] [drugs/medications/treatments]? As a [certified/credentialed/licensed/Master’s level] [registered dietitian/nutritionist/nutrition professional], I’d love to help.
Want support to create a nutrition and lifestyle program to make losing weight easier? Need personalized recommendations for recipes, meal plans, and other ways to ensure you’re getting all of the necessary nutrients in the optimal amount of food to reach your health goals? Ready to start working with a professional who is invested in seeing you thrive, despite weight management challenges?
Book a free appointment with me today to see if I can help you reach your goals. 🙂
National Center for Health Statistics. (2018, July). Attempts to Lose Weight Among Adults in the United States, 2013–2016. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db313.htm
Okay, so, let's get real. No matter how healthy we want to eat, no matter how much we want our kids to eat the perfect diet, no matter how much we want to avoid processed food, real life exhausts us sometimes.
Even the natural born chefs among us don't always feel like cooking.
And even the most frugal among us end up eating out eventually. Not only that, but like I mentioned in my last post on fast food, we don't just eat out for the food. We eat out to be social, to relax, to feel closer to our loved ones and our friends.
So, what do we do when we find ourselves in the “forbidden” restaurant? Sip on a lemon water? Pretend we're not hungry?
No! We choose healthy or we balance what we eat the rest of the day with what we eat at the restaurant.
Firstly, lets talk about balancing what we eat the rest of the day with what we eat at the restaurant.
When my family decides to eat out, we often eat at Sweet Tomato (Soupplantation). This is because (I'm laughing) Sweet Tomato is our son's favorite restaurant. Why? Because he likes the macaroni and cheese! I have to twist his arm to get him to eat a tablespoon of shredded carrots or a slice of cucumber with his macaroni and cheese, but he does drink apple juice (that is actually his preference).
Even at Sweet Tomato, the calories add up fast. I generally will eat some of the green salads and my favorite Broccoli Madness as well as a tad of Tuna Tarragon pasta salad. And the herb focaccia is fabulous! I like to try out the monthly soups, though there are a few classic favorites like cream of mushroom, chicken noodle that are my mainstays.
MyFitnessPal has most of the menu items from Sweet Tomato in their database, so I can estimate my calories eaten. Usually, when I eat there, it ends up being around 700 calories. This is over half of my calorie allowance when I don't work out.
When I eat at Sweet Tomato (or any other restaurant), I try to make sure I go to the gym and workout.
This increases my calorie allowance by an extra 300-500 calories. Also, at Sweet Tomato, the salads and soups have calorie and fat information next to the food. So you can estimate as you go, if you're into doing that.
So what else can we do when eat out to make sure we don't completely blow our diet?
Here are 10 healthy choices when eating out I have found to be helpful when eating out.
Check the nutrition facts information on the restaurant's website. Restaurants are required to make nutrition and allergy information available to customers. 99.9% of restaurants nowadays have websites that you can access anywhere, including your mobile device.
Choose the lower calorie option. For example, if you're at McDonalds, and you're itching for a hamburger, buy the smaller hamburger. You can also ask for no sauce. For example, with the Big Mac, you can save 90 calories by ordering it without the sauce.
If you must have the high calorie option, eat half at the restaurant and save the other half for later.
Order just the sandwich and a salad instead of French fries OR order just a salad.
Pay special attention to calories in salads, however. Salads sometimes have more calories than a large cheeseburger, depending on what's on them.
Use low calorie salad dressing or limit the amount of regular dressing you put on your salad.
Order the sandwich without cheese.
Drink water instead of soda.
Remember that just because it's healthy doesn't mean it's lower in calories. For example, the Green Burrito Bean, Rice and Cheese burrito has more calories than a Carl's Famous Star with Cheese (Green Burrito and Carl's Jr exist together at many restaurants, in case you didn't know that).
What attracts kids to Fast Food? I recently received an email from a subscriber. She wanted advice regarding her 17-year-old son. Her son was raised on a healthy diet since birth, but now only wants to eat at fast food restaurants. This is a concern that I believe many parents have as their kids hit the teen years.
So, what is going on here? Why do teens often prefer to eat at fast food restaurants to eating at home? Is it just about the food? Or is there something else going on that causes so many kids to want to eat more fast food as they get older? In other words, what attracts kids to fast food?
Teens are Exerting their Independence
One of the things about teens is that they are exerting their independence. They want to call the shots. One way they can do that is by taking charge of their own food intake. When they go out and eat at a restaurant, mom and dad don't have to be there. So, the teen can eat whatever he or she wants. Plus teens usually like being around friends, so eating out becomes an opportunity for social interaction. They could bring their friends home, but that wouldn't be the same because mom or dad would be there too.
So What Attracts Kids to Fast Food?
I read a book years ago titled, “Fast Food Nation.” It was an excellent book that discussed the psychology behind eating at a fast food restaurant. For example, the author, Eric Schlosser, discusses how eating at McDonald's is an “experience.” People don't go to McDonald's simply because the food is so amazing. They go to McDonald's because McDonald's is effective in creating a positive image of themselves as a “Trusted Friend.”
Not only that, Schlosser writes,
“Over the last three decades, fast food has infiltrated every nook and cranny of American Society…Americans now spend more money on fast food than on higher education, personal computers, computer software, or new cars. They spend more on fast food than on movies, books, magazines, newspapers, videos, and recorded music–combined…
“The whole experience of buying fast food has become so routine, so thoroughly unexceptional and mundane, that it is now taken for granted, like brushing your teeth or stopping for a red light. It has become a social custom as American as a small, rectangular, hand-held, frozen, and reheated apple pie.” (emphasis mine).
In other words, kids are growing up in a culture where eating at fast food restaurants is promoted as part of what you're supposed to do if you're an American.
In another book, “Consuming Kids,” the author Susan Linn is helpful making the reader more aware of how much money and effort fast food manufacturers spend to make their products attractive to kids. For example, McDonald's spent $1.3 billion in advertising in 2002 in the US alone. PepsiCo spent more than $1.1 billion. I'm sure it's much higher today.
So, we can come up with recipes and find healthier “fast food” alternatives that fit in with our busy schedule. And I'm sure this will help encourage our kids to eat healthier at least some of the time. However, we should remember that no matter how good the food is at home, our kids will probably want to eat out more as they get older, especially if they have a lot of friends.
Healthy Fast-Food Picks for Kids
So, what can you do to tempt your child to eat more at home so that you can be sure she is getting the nutrients she needs?
If your teen likes hamburgers, you can serve hamburgers at home.
A hamburger served at home with lean beef or turkey is definitely healthier than a fast food hamburger. Especially since you can use a whole grain roll and offer healthy side dishes, including homemade French fries (see below for recipe). And if making a hamburger from scratch is a burden to you time-wise. There are pre-made burgers available that are definitely more healthy than a Burger King burger is. We shop at Costco, and they have delicious chicken burgers that you can buy and pop in the microwave, pan or BBQ grill for a quick burger. That could help with the time factor.
If your teen likes to eat chicken at fast food restaurants, like KFC, there are alternatives for that too. Again I mention Costco, because they have the best rotisserie chickens! Costco actually loses money when they sell their chickens for $3.99 (not a typo). I have done my research. Costco's chickens are raised humanely and are free-range, plus they have no added hormones or other junk.
We are a family of three, and one chicken lasts several days. My husband and son like dark meat, and I like white meat. So, we always have extra white meat to use on sandwiches, chicken rice soup, or chicken tomato tacos and burritos.
If you don't have a Costco nearby or aren't a member, you can also get Rotisserie chickens at the grocery store. We sometimes get chickens at our regular grocery store, but they aren't quite as good or as inexpensive. It's still an option, however. If you are concerned about the ingredients, ask the deli manager about the food prep process.
The chicken nuggets recipe calls for frying the chicken. However, because you are making it at home, you don't have to worry about the artificial additives used in fast food restaurants. Also, the sodium will be a fraction of the amount of sodium you will get in a restaurant. For example, in our recipe, there is only 91 mg of sodium per serving. In contrast, a four piece order of McDonald's chicken nuggets contain 340 mg sodium, not to mention a long list of questionable ingredients.
When we made the chicken nuggets the first time, I felt guilty afterward because we fried them and could have baked them. However, my son loved the fried version, but may not have liked the baked ones because they would have been drier.
What Attracts Kids to Fast Food? It's All About Balance
Like I've said in previous posts, homemade will almost always be healthier than processed. Just make sure you use canola, corn, or other unsaturated oil.
Speaking of the oil you use. Years ago, McDonald's and other fast food restaurants used beef tallow to fry their French fries. Now they use whatever is acceptable at the moment because they don't want to lose customers. A little trivia for you! 🙂
As an alternative to fast food french fries, homemade fried or baked fries made from fresh potatoes would count as a vegetable. Because french fries are technically a vegetable. The main problem with French fries from a fast food restaurant is that the potatoes aren't fresh, so the vitamin C is long gone. However, fresh potatoes made at home are high in vitamin C, and the skin is high in iron and fiber. See below for homemade French fries recipe.
A Few Other Ideas
Does your teen like to cook? Maybe he can help with the prep.
It's obviously a lot more work to make homemade burgers and fries than it is just picking up a burger and fries at your local fast food restaurant. However, if your teen likes cooking, or has elective requirements to meet for high school graduation, you can use this as a teaching and family bonding opportunity.
Does your son or daughter have a favorite vegetable they will eat? One that others in the family like as well? Buying already cut up fresh or frozen is one way to save time. I don't recommend canned because canned vegetables are filled with sodium. But frozen is almost as healthy as fresh. Plus it has a longer shelf life, so you can stock up for when you are in a hurry or are too tired to cut up vegetables.
Does your teen sometimes grab a burger and bring it home to eat? If he brings a hamburger or something else home with him, you can encourage him to eat a salad or other favorite vegetable with it. There's also fruit! Making his favorite vegetables and fruits readily available for him to eat can also help to balance the fast-food habit.
The good news is that there are healthy choices at most restaurants. If your teen eats out a lot but tries to order the healthier choices, praise her for it. If not, you can point her to the restaurant food site for nutritional facts to help with making the best decisions.
I'm a Registered Dietitian and I make use of restaurant websites to help me control my calories when I plan to eat out.
Because of government regulations, all restaurants are required to make the nutrition facts available on their menu items.
Hopefully, these tips will help relieve some of the anxiety you have about your teen's growing independence, attraction to fast food, and other not so healthy food choices.
If you have any other questions, feel free to comment on this post or send me an email. I'd love to hear from you!
For further reading, my own articles on this site:
Not low fat, but still delicious and made from fresh potatoes which are high in Vitamin C and potassium. If you keep the skin on, you also increase the fiber and iron.
Prep Time10 minutesmins
Cook Time15 minutesmins
Total Time25 minutesmins
Course: Side Dish
Cuisine: American
Keyword: frugal, kid friendly recipes
Servings: 4Servings
Calories: 292kcal
Author: Deborah Hanyon, MPH, RDN, ACE-CHC
Ingredients
1CupAvocado oilAmount will depend on size of pan, amount of potatoes made
4LargePotatoesOne potato per person; Russett are best; wash and scrub thoroughly
1tspGarlic SaltLawry's is the one we use because it doesn't have any artificial ingredients
Instructions
Add oil to large non-stick pan
Heat to 375 degrees Fahrenheit
While oil is heating, cut potatoes into wedges. Cut potato in 1/2, and then in 1/2 again, and then 1/2 until wedges are about 3/8' square size.
When oil is ready, add potatoes carefully to pan using a pair of tongs
Cook potatoes until golden brown, about 15 minutes.
Drain on a paper towel covered plate for at least five minutes. Pat french fries with paper towels to remove excess oil.
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