There's no magic bullet yet -- but for people with obesity, weight loss drugs can be a helpful part of treatment.However, weight loss drugs like Xenical do exist. They also work. And pharmaceutical companies across the globe are industriously working on more. They're not for cosmetic use, so mildly overweight people fretting about bathing suit season shouldn't apply. Their effects are also modest, usually resulting in a loss of no more than 10% of a person's body weight. Contrary to some hopes, they don't replace diet and exercise; weight loss drugs only work in conjunction with lifestyle changes.
At the most basic level, your weight is determined by the balance between the amount of energy you take in and the amount you expend -- the food you eat and the calories you burn. If you burn more calories than you eat, you'll lose weight; if you eat more than you burn, you'll gain. However, while that equation is still roughly true, researchers have found that it's a lot more complicated. The body has many complex and interacting mechanisms that help regulate your weight.
The FDA has approved the use of weight loss drugs in people with a BMI of 30 or as low as 27 in some people who have illnesses related to obesity, like diabetes or heart disease. The BMI is a measurement based on height and weight. According to the National Institutes of Health, a normal BMI ranges from 18.5 to 24.9, 25-29.9 is overweight, and anything above that is obese.
As much as people may dream of the pill that lets them lose weight without diet or exercise -- the claim of countless hucksters and infomercials -- none of these drugs works that way. Studies have shown that these drugs really only work in conjunction with lifestyle changes. The amount of weight that people lose on weight loss drugs varies: Some people have great success and some don't. On average, people don't lose more than 10% of their baseline weight -- that's a 20-pound weight loss for a person who is 200 pounds. Generally, people lose the most weight in the first three to six months on the drugs and then plateau.
So barring some unforeseen breakthrough, weight loss drugs are not going to be "the answer" to obesity any time soon. But along with diet and exercise, they can be an important part of the solution.
Of the many years of struggle with excess adipose tissue, mankind has learned several lessons. Firstly, sometimes there are too many good people, and then they need to be treated. Secondly, it’s far from always that it’s enough to run in the mornings and give up sweets. Thirdly, not all treatment methods are equally useful. We have compiled a list of officially approved medications for obesity and tell you how and to whom they can help.
To begin with, we will determine what excess weight is. From a medical point of view, weight may be superfluous only for the body and its work, but not at all for the self-esteem of its owner. Therefore, when we talk about obesity, we are not talking about the fact that a dress does not sit on someone. We are talking about the fact that adipose tissue “sits” on someone’s organs and prevents them from functioning normally. And this, you see, is a much more serious problem. The World Health Organization suggests not believing in a mirror, but in body mass index (BMI). Take the body weight (in kilograms) and divide by the square of growth (in meters). You can begin to get nervous if the index is more than 25 - this is recognized as overweight. And only after 30 begins real obesity.
Digging deeper and see where overweight comes from. To do this, go along the path that food passes along the road to body fat-
Where can this system fail? The most obvious is if the food intake is greater than the energy expenditure. In other words, a person eats too much or moves too little. In addition, the mechanisms by which the organs regulate each other's work can break down. For example, the connection between adipose tissue and the pancreas often breaks down. The latter secretes insulin, which stimulates the capture of sugar from the blood. If the body does not produce enough insulin (type 1 diabetes mellitus), people do not get fat - their adipose tissue does not receive a signal to store food. But with type 2 diabetes, the opposite is true: if a person has too many reserves (obesity), then his tissues may lose sensitivity to insulin, and sugar will accumulate in the blood.
But this is only the tip of the iceberg. Do not forget that all of the above steps are connected with each other by dozens of signal molecules. The stomach signals the brain whether there is enough food. Adipose tissue releases substances that reduce appetite. And the brain, in turn, gives the command to eat more or digest more intensively. And this we do not yet take into account the kilograms of bacteria in the intestines, which also have an opinion about our digestion and also actively express it, that is, they release signaling substances. Therefore, when we are dealing with obesity, it is sometimes very difficult to say what exactly went wrong. Anything could break.
Since there are many causes of obesity, it can be treated in different ways. There are simple methods: eat less or spend more energy. This includes all kinds of diets and physical activity. However, it often happens that they do not help. This means that the problem is not in the balance of stocks and expenses, but in regulatory mechanisms. There are many dubious methods used by people with eating disorders: laxatives (so that food is not absorbed), diuretics (when dehydrated, fats are also often broken down), antidepressants (so that you don’t want to eat), etc. These methods usually apply harm to health, but they still don’t solve the problem.
Orlistat (Xenical, Alli) belongs to them - the only drug for weight loss, which in the USA can be purchased without a doctor’s prescription. It blocks lipase, an enzyme that breaks down fat in the intestines. This allows you to reduce their absorption by 30%, without affecting the rest of the metabolism. And since fat does not enter the bloodstream, then we cannot store it. According to clinical studies, over 4 years, patients taking orlistat lost an average of 5.8 kg. In the control group taking a placebo, 3 kg each. Here we note that usually it is recommended to combine drugs for weight loss with diet and exercise. Therefore, we can say that part of the weight loss of participants in such tests is almost always provided not with a drug, but with a change in lifestyle. As a side effect of orlistat, steatorrhea (fatty stools) is possible, which can be avoided by eating less fatty food. In addition, in some cases, the drug had a negative effect on the functioning of the liver, kidneys, and pancreas. However, these cases were rare, besides, do not forget that obesity in itself is often accompanied by a malfunction of the internal organs.
In America, liraglutide (Saxenda, Viktoza) is used. It is an analog of the glucagon-like peptide 1 (GLP-1), which acts on the pancreas and enhances the production of insulin. And insulin, in turn, reduces appetite. This drug is designed for people with type 2 diabetes (low sensitivity to insulin), and, unlike the others, is for injection. After 56 weeks of daily injections, people dropped to 8.4 kg. If used by people who are not diabetic, hypoglycemia is possible - a decrease in blood sugar - which in extreme cases can lead to a coma. Other side effects from the digestive (diarrhea, constipation, nausea) and nervous (headache, dizziness) systems are possible.
Signals between neurons in the brain are transmitted through small molecules - neurotransmitters. Depending on which neurotransmitters are released, different neurons are activated. If the signal goes along the sympathetic nerve fibers, a stress response is triggered. The body focuses all forces on survival, while the heart and lungs are actively working, and digestion, for example, is inhibited. If the signal goes along parasympathetic fibers, the body relaxes. The heart and lungs work quietly, but more energy is spent on digestion and excretion. Anorexics mimic the work of neurotransmitters and trigger a stress response. This allows you to reduce the activity of the center of hunger and strengthen the splitting of energy reserves.
To date, several two types of anorexics are used: 1) lorcaserin (Belvik) - reduces appetite by activating the serotonin receptor, known as the 5-HT 2C receptor - and 2) diethylpropion (Tenuate), phentermine (Adipex), fendimethrazine (Bontril), benzfetamine (Modex) are relatives of amphetamines.
Lorcaserin is the mildest. He was suspected of provoking cancer and depression, but fears were not confirmed. According to clinical studies, lorcaserin acts better in the first months, and then its effect decreases. On average, over a year on lorcaserin, people who are obese and overweight due to diabetes lost about 4.5-5% of their weight (versus 1.5% on placebo).
Unlike lorcaserin, the rest of the anorexic drugs the Food and Drug Administration (FDA) does not recommend for a long time, because they are addictive (not for nothing that they look like amphetamines). Due to addictive behavior and possible serious side effects in case of an overdose, anorexics are not sold without a prescription, and their turnover in the United States is under strict state control.
However, not so long ago a milder option appeared - Phentermine + Topiramate(Ximiah). It is already recommended for long-term use. The exact mechanisms of action of topiramate are still unknown. It was used earlier as an anticonvulsant in the treatment of epilepsy, it increases the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid). This probably helps to avoid getting used to phentermine, without interfering with its action. Over 56 weeks, with the help of Ximia, patients lost up to 10 kg of weight. However, with all the softness, Ximia also has unpleasant side effects. It reduces the amount of female sex hormone Ethinyl estradiol in the blood, which worsens the effect of oral contraceptives and increases the likelihood of bleeding. In addition, among patients taking Ximia, the frequency of anxiety disorders and depression is 4–7 times higher. Therefore, it is not recommended for people prone to depression.
This group includes naltrexone + bupropion(Contrave). Naltrexone blocks opioid receptors - those that are responsible for the invigorating effect of endorphins (“hormones of happiness”) and many narcotic substances (morphine, heroin, etc.). Naltrexone is used to treat alcoholism and drug addiction, while patients cease to enjoy and the addiction is removed. Bupropion works differently. When one neuron transmits a signal to another, it releases neurotransmitters, but after some time captures them back. Bupropion interferes with the reuptake of dopamine (a stimulating neurotransmitter) and norepinephrine, therefore it acts as an antidepressant, and the patient is less hungry. With the help of Contrave, study participants dropped about 5-6% of body weight over 56 weeks (1.3% in the placebo control group). Although here it can’t do without side effects - nausea, dizziness.
To summarize. Obesity is a serious disease. It can be pre-diagnosed by body mass index. You can deal with it in simple ways, controlling your lifestyle and restricting yourself in food. But if this does not help, treatment should begin.