Weight loss medications: What are my options?

In his latest online article, leading specialist in metabolic medicine Professor Carel Le Roux delves into the different weight loss medications currently available, including Semaglutide, Mysimba and Orlistat.

How does Semaglutide work and what are the side effects?

Semaglutide works by addressing the root cause of obesity. Treating the disease obesity leads to its control, resulting in weight loss. Initially, weight loss occurs over approximately a year, stabilising in the long term with continued medication use.

Like all medications, Semaglutide also has side effects. Initially, some individuals may experience nausea, but this symptom typically diminishes over time. Others may encounter constipation, which can be managed through lifestyle adjustments, such as increased water intake, a higher fibre diet, or improved bowel habits.

A significant amount of weight loss, whether through diet, medication, or surgery, can sometimes be associated with gallstones. This is very rare, with roughly three in a hundred people developing gallstones. AN even smaller proportion, about two or three in a thousand, might experience a rare complication known as pancreatitis. In such cases, stopping the medication prevents long-term issues.

How does Mysimba work and what are the side effects?

Mysimba combines two older medications, naltrexone and bupropion, both well-understood in terms of their functions and expected side effects after decades of use. This combination decreases hunger and cravings for food in approximately one in three individuals, leading to an average weight loss of around 10%.

Operating within the part of the brain associated with obesity, Mysimba's effectiveness is tied to its impact on the brain's disease of obesity. Side effects may include initial nausea, which tends to decrease over time. Some may experience insomnia, hence the recommendation to take the tablets in the morning or at midday, but not in the afternoon or evening. Individuals with epilepsy cannot take this medication due to the potential risk of seizures, although epilepsy is rare in those with obesity. Adjusting doses of medications for depression may be necessary to prevent serotonin syndrome when using Mysimba.

How does Orlistat work and what are the side effects?

Orlistat, a medication in use for over three decades, works solely within the gut and isn't absorbed into the bloodstream, resulting in minimal side effects. It functions by blocking about a third of the fat consumed. However, if a significant amount of fat is eaten, approximately one-third of it passes through the body, causing severe diarrhoea. It's crucial to manage fat intake to avoid this effect and achieve substantial weight loss.

Ultimately, these medications assist in making informed choices, and transitioning from mindless to mindful eating habits.

Why does weight loss plateau one year after medication usage?

Patients often question why weight loss plateaus approximately a year after starting medication, sometimes at a higher weight than desired. The reason lies in the fact that treatments for obesity aim to control the disease, resulting in weight loss. While weight loss cannot be precisely predicted before treatment initiation, it tends to stabilise around three months into the treatment. Weight stabilization doesn't indicate that the medications have stopped working; rather, they are effectively controlling the disease.

Discontinuing the medication causes the disease to relapse, leading to increased hunger, decreased satisfaction, and long-term weight gain. The goal isn't solely weight loss but overall health improvement. Sustained weight loss maintenance is crucial for long-term optimal health with these treatments.

If you would like to book a consultation with Professor Le Roux, you can do so today via his Top Doctors profile.