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This a question I am frequently asked by patients, and the answer is yes. Medications for weight loss, also known as anti-obesity medications can be prescribed by healthcare professionals to help individuals manage their weight after diet and exercise or lifestyle measures alone have not proved sufficient. They are licenced if body mass index (BMI) is over 30(or 27 if they have accompanying health issues like type 2 diabetes). It's important to note that these medications should only be used under the supervision of a qualified healthcare provider, as they can have side effects or even be unsafe if not used correctly and are not suitable for everyone.
When looking at these medications it is useful to take into account their risks/benefits and any reasons you may not be able to take them along with the cost of these. None are currently Pharmac funded.
There are four medications currently available in Aotearoa, New Zealand.
1. Orlistat (Xenical) - $100 per month*
With 20 years of use, it remains the longest licensed anti-obesity medication. Unlike others on the market, orlistat does not exert its effect by affecting appetite; instead, it reduces calorie absorption by blocking the absorption of dietary fat in the intestines & reducing calorie intake. It is taken up to three times daily with meals. It can not be taken if you have a history of gallstones or malabsorbtion.
In a large randomized controlled trial that evaluated the effect of orlistat in 3,305 patients, orlistat was found to cause a total bodyweight loss of 2.4% after 4 years. More importantly, it significantly lowered the risk of type 2 diabetes mellitus.
Common side effects include gastrointestinal issues such as diarrhoea, gas, and oily stools.
2. Buproprion-Naltrexone (Contrave) - $240per month*
Contrave is a combination of two medications, bupropion (an antidepressant) and naltrexone (used to treat addiction). It works on the brain's appetite control centres and the reward system. Clinical trials have shown while taking naltrexone/bupropion 32/360 mg for 56 weeks compared to placebo weight loss was 6.1% vs. 1.3%, 6.4% vs. 1.2%, and 9.3% vs. 5.1%,respectively.
There are many reasons this medication may not be suitable, including history of certain mental health conditions or very high blood pressure. Your doctor should be able to advise you on whether this is safe for you. Common side effects include nausea, headache, and constipation.
3. Phentermine (Duromine) - $105per month*
Phentermine is a prescription appetite suppressant that is often used for short-term weight loss.
It stimulates the release of certain neurotransmitters in the brain that reduce appetite.
Again there are numerous health conditions such as heart disease or certain mental health diagnoses which would preclude someone from taking this and careful discussion with your doctor is essential. It can also interact with some medications. Common side effects include increased heart rate, high blood pressure, and insomnia.
4. Liraglutide (Saxenda) - $600*
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist originally developed to treat diabetes. It has also been licenced as a weight loss medication because it helps reduce appetite and increases feelings of fullness.
In the SCALE clinical trial After 56 weeks, a weight loss of8.0% was achieved in the liraglutide group (vs. 2.6% of placebo) and 63.2% and33.1% of the participants in the liraglutide group achieved ≥5% and ≥10% weight reduction. Common side effects include nausea, vomiting, and diarrhoea.
It's important to consult with a healthcare provider before starting any weight loss medication, as they can assess your individual needs, discuss potential risks and benefits, and monitor your progress.
It is also important to understand that for all of these medications, even though they may assist you in loosing weight, if there is no underlying change in lifestyle, ie incorporating regular movement, and keeping food intake within limit of what your body needs, then weight loss is unlikely to be sustained.
Following weight loss you may be left with excess skin, which can be alleviated with skin tightening procedures such as abdominoplasty(tummy tuck), body contouring, arm or thigh lift, all performed by Dan Butler in Tauranga.
*costs are approximate and may vary
References:
1. Anti-Obesity Drugs: Long-Term Efficacy and Safety: An Updated Review. Young Jin Tak and Sang Yeoup Lee, World J MensHealth. 2021 Apr; 39(2): 208–221.