Exploring Weight Loss Drugs and Their Effects

According to a March 2024 report published in the medical journal The Lancet, around eight crore Indians are obese, including one crore people between the ages of five and 19. That is officially an obesity epidemic. That means around 70% of the urban population is obese. Since obesity is considered one of the key reasons behind a lot of diseases, weight loss and weight management are significantly substantial.

Given the fast-paced current age, where we are so used to instant gratifications (thanks, Meta), we simply don't have the time to hit the gym or eat healthy. So, pills are the only option. They are small, take less than a second to pop, and work by themselves internally. Some feel they are the same magic pills from the games that magically grant your wish to have a body like Cristiano Ronaldo.

These pills are often marketed with the face of some super-toned superstar to make us feel that the stars also use the same pills (I know you already know this, but this clearly works). We ignore that the superstar probably spends four hours in the gym, follows a diet that we can't even imagine, and stacks thousands to look that way; no, it's the pill for us. That begs the question, do these pills work? If they didn't, they wouldn't be sold in droves either. So what's the catch? Let's explore!

Amphetamines (1950s-1970s)

You have a central nervous system. Amphetamines speed that up by increasing the number of neurotransmitters, especially Dopamine, Norepinephrine, and Serotonin. Along with the growth in amphetamine use for psychiatric disorders, early years also saw it being used for weight loss - without being approved by the AMA. Amphetamines, as early fat burners, were quickly withdrawn from use because of a propensity for addiction and withdrawal symptoms.

Fenfluramine (1970s-1990s)

In the early 1960s, this drug was introduced as an appetite suppressant in France in 1963, followed by approval in the US in 1973. Taken together with phentermine as "fen-phen", this drug started causing cardiac issues. Thus, it wasn't very successful as a weight loss medication.

Orlistat (1990s-2000s)

This drug is only for use in overweight or obese adults. This pill works by blocking the enzymes in the gut that create fat. This prevents around one-third of the fat that you consume from being absorbed into your body, after which it is passed out in your stool. It has side effects like bladder pain, body aches, chills, coughs, diarrhoea, difficulty breathing, ear congestion, and fever.

Sibutramine (2000s)

This serotonin and noradrenaline reuptake inhibitor promotes weight loss by affecting hypothalamic 5-HT2A, 2B, and 2C receptors, stimulating sympathetic activity and increasing energy expenditure. It brings down hunger and promotes satiety, helping in weight loss. This wasn't very successful as a weight loss medication because, among patients with pre-existing cardiovascular issues, Sibutramine was associated with increased adverse cardiovascular events.

Rimonabant (2000s)

Rimonabant, a selective cannabinoid-1 receptor, was rejected by the FDA because of its psychiatric side effects. It regulates food intake from peripheral and central actions. According to research, using Rimonabant for a year produces around 5% of weight loss. According to data from clinical trials submitted to regulatory authorities, Rimonabant caused depressive disorders or mood alterations in up to 10% of subjects and suicide ideation in around 1%. Suicide ideation is a serious subject.

Phentermine-Topiramate (Qsymia)

This drug might also be used for some other conditions, as your healthcare provider determines. Qsymia contains two medicines called phentermine and topiramate. They work together to help people lose weight by reducing appetite, which might help you want to eat less food. Topiramate might also help you feel full. However, the exact mechanism of these medicines is unknown. The only issue with Qsymia is that it causes increased heart rate.

Lorcaserin (Belviq)

Imagine you were prescribed weight loss medication only to have it increase the incidence of cancer. That's precisely what happened with the manufacturer of Belviq and Belviq when the FDA, on the 13th of February 2020, asked them to withdraw their drug from the US market because a safety trial showed an increased cancer occurrence.

Naltrexone-Bupropion (Contrave)

Contrave is the brand name of this medication. It is used to reduce hunger and helps with cravings. Some long-term side effects include liver damage and angle-closure glaucoma.

Liraglutide (Saxenda)

If you have excess weight (BMI≥27)and are suffering from a weight-related medical issue or obesity with your (BMI ≥30). Liraglutide Saxenda injection is prescribed to help you lose weight. What are the side effects? Nausea and vomiting.

Semaglutide (Wegovy)

This appetite suppressant works quickly for weight loss within a few weeks. Your appetite will fall within a day or two. The US FDA approves this glucagon-like peptide-1 (GLP-1) receptor agonist as three brand-name medications: Ozempic, Wegovy and Rybelsus. Once a week, Semaglutide for weight loss is injected under the skin.

Tirzepatide (Mounjaro)

This dual GIP/GLP-1 receptor agonist produced 20-25% weight loss in clinical trials. It is a 39-amino acid peptide similar in size to these hormones, which are involved in insulin secretion and food intake. This drug led to mean reductions in body weight by up to 20.9% after 72 weeks of treatment.

Personalised medicine - Genetic profiling for optimal drug selection

Genetic profiling allows you to select weight loss drugs tailored to an individual's genetic makeup. Optimising drug efficacy and minimising side effects aligns treatment with a patient's unique genetic characteristics, ensuring safer weight management.

Combination therapies - Pairing drugs for better efficacy and safety

Combining different weight loss drugs can boost efficacy and safety. One needs to understand what physical fitness is in order to attain a weight that is healthy and robust, not just backed by the social norms.

By combining medicines with complementary mechanisms like appetite suppression and metabolism boosters, combination therapies give you more comprehensive solutions for weight loss, with better results and fewer side effects.

Digital health and lifestyle intervention

In addition to slimming pills, digital health tools like wearables and apps support weight management by boosting patient engagement. Such technologies allow you to track your diet, exercise, and progress in real-time to stick to your goals and make informed lifestyle changes.

The days of spot reduction of fat are a thing of the past and people are focusing on natural ways to stay fit, concentrating on lifestyle choices and food habits.

Endocrinologists and obesity specialists

Experts in endocrinology and obesity focus on hormonal and metabolic factors influencing obesity, providing advanced treatment and personalized care plans that tackle weight gain and promote effective, long-term weight management strategies.

Long-term weight-management strategies are not just following fad diets but following sustainable strategies that one would be able to follow through out their life, therefore changing their entire lifestyle.

As prescription weight loss drugs evolve, they reflect the strides made in science and understanding obesity. From new weight loss medications and early stimulants to new-age GLP-1 receptor agonists, each generation has new insights and solutions. As we look towards the future, personalized treatments and combination therapies may become the norm, boosting efficacy and bringing downside effects for effective weight management.

Does semaglutide help you with weight loss?

This is an appetite suppressant and a glucagon-like peptide-1 (GLP-1) receptor agonist that can help you lose weight.

Can I lose weight by taking Qsymia?

While Qsymia might be prescribed for other medical conditions, it contains two medicines called phentermine and topiramate that might work together to help people lose weight by cutting down their appetite so you want to eat less food.

How to lose weight in 7 days?

Stop eating processed foods and added sugar. Drink more water and eat more fibre. Many factors influence your weight loss ability. Look to lose weight in a slow and sustainable manner, like around 0.5 to 2 lbs per week.