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“And aren’t there any pills for that?” You’ve probably thought something similar when trying to lose weight. Perhaps you were even more captivated by the idea of this simple solution when you recently learned that celebrities like Elon Musk have quickly achieved their desired shape thanks to the miracles hidden behind the names Ozempic and Wegovy.
Weight loss medications, also known as anti-obesity drugs, have quickly made their mark on the world, offering many a glimmer of hope. After all, the idea of simply taking a weight loss pill with breakfast to become slim and fit effortlessly seems enticing, especially when headlines from Hollywood suggest that this might serve as a weapon against the growing obesity epidemic at our fingertips. But is it really that simple, or is there more complexity to these medications? [8,16]
This article will cover the following weight loss medications:
Why are weight loss medications such a hot topic?
Who wouldn’t be tempted to lose weight with the wave of a magic wand? Changing one’s diet, exercise habits, and overall lifestyle is quite challenging and often ends in failure. Understandably, we eagerly embrace anything that might simplify weight loss for us.
Many people imagine weight loss medications as a quick route to their desired body shape. Media reports, especially when they attribute weight loss success to celebrities like Oprah Winfrey or Sharon Osbourne, often reinforce this idea. Their effectiveness is evident, and that’s why so many people think that there’s finally something to break them out of the endless cycle of dieting and yo-yo effects. [20,25,26]
These medications become even more appealing when you know that doctors prescribe them for obesity therapy. Naturally, you might assume that if they help with obesity, they could also be useful for you.
How do weight loss medications work?
Weight loss medications are not just a gimmick. After all, obesity specialists routinely prescribe them to patients with obesity who need a helping hand with weight loss. These medications are primarily intended for them.
In weight loss pills, there are active ingredients that can affect various physiological processes in our bodies and truly help with weight loss. The fact that they are medications also helps their credibility. For a pill to become a medication, it must undergo numerous tests and clinical trials. When these trials show that it works and is safe to use (in prescribed doses), it can be registered as a medication. In the European Union, the European Medicines Agency (EMA) oversees this pivotal step, while in the United States, it is the responsibility of the Food and Drug Administration (FDA). [15]
Not all weight loss medications are the same. Under names like the well-known Ozempic or Saxenda, there are several mechanisms of action. These medications, therefore, work in different ways and can shuffle the cards in several physiological processes in our bodies.
What are the mechanisms of action of weight loss medications?
1. Suppressing appetite
These medications act on centers in the brain and influence how you perceive hunger or satiety. They can make you feel less hungry, and they often reduce cravings for sweet and salty snacks, which are commonly the culprit of the issue. They also help you feel full faster, even after eating a smaller portion. This allows you to reduce food intake more easily and thus achieve a caloric deficit for weight loss. You might recognize these medications by names like Mysimba or Adipex retard.
2. Limiting nutrient absorption
Some medications aim to prevent the complete digestion of nutrients (usually fats or carbohydrates). These nutrients then cannot be absorbed into the bloodstream and converted into energy, reducing calorie intake. For example, a meal that has 400 kcal might yield only 300 kcal when combined with one of these medications, as the remaining calories are expelled from the body in the form of undigested fat or carbohydrates. In a way, they can act as carbohydrate or fat blockers. A well-known example of this is Orlistat.
3. Mimicking hormones of the digestive system
Our digestive system naturally produces so-called incretins, hormones such as GLP-1, which further influence the secretion of insulin and glucagon. On one hand, they promote the production of insulin, which can then lower blood sugar levels (glycemia). This is why these medications are primarily intended for the treatment of type 2 diabetes.
However, they have also proven effective in weight loss, particularly due to their ability to slow down gastric emptying. This keeps the stomach fuller for longer, prolonging the time until hunger strikes. Additionally, they help promote satiety by influencing the brain centers responsible for feelings of hunger and fullness.
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What weight loss medications do we know?
For someone looking to shed excess fat and turning to weight loss medications for help, there are several options available. Since a medical prescription is required to obtain them, it’s up to the doctor to choose the one that best targets the main problem. It’s also important to discuss with the doctor any side effects that may occur during use. While the following medications are generally safe, as is typical of medications, they may still come with unpleasant effects.
1. Orlistat – Xenical, Alli
The active ingredient orlistat has been a mainstay in the weight loss medication market. It officially entered use in the European Union as early as 1998 with the registration of the first medication, Xenical. Xenical is still in use today and requires a medical prescription. Orlistat is also found in the medication Alli, which joined its older sibling in 2007. The younger sibling with a lower dose of orlistat can be purchased and used even without a doctor’s prescription.
How does orlistat work?
Orlistat aims to prevent the complete digestion of fat from food. Undigested fat cannot be absorbed from the digestive system into the bloodstream and therefore cannot be converted into energy. By this mechanism, orlistat reduces calorie intake from food.
It specifically targets gastric and pancreatic lipase, enzymes that break down fats into glycerol and fatty acids in the stomach and small intestine. Orlistat inhibits their activity, preventing some fats from being broken down, and instead, they are excreted from the body in the stool. [7,9]
Is orlistat effective?
Orlistat boasts quite respectable results. It is reported that when taken at the recommended dose before meals, it can reduce the absorption of fat from that meal by roughly 30%. Imagine a lunch that contains 40 g of fat. By taking orlistat before diving into it, you can prevent the absorption of about 12 g of fat (30% of 40 g). Since 1 g of fat contains 9 kcal, this medication can reduce the calorie content of lunch by a total of 108 kcal. Of course, this only applies when the meal contains fat. That’s why it’s intended for people whose problem lies in a high-fat diet.
Does orlistat have side effects?
Although the effect of orlistat may seem like a fairy tale at first glance, it is not without side effects. The most common ones are digestive problems because undigested fat can cause diarrhea, gas, or even stool leakage. Abdominal pain or flatulence may also occur. When taking it, it’s also important to consider that it may reduce the absorption of fat-soluble vitamins (A, D, E, K). [4,9]
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2. Naltrexone-bupropion – Mysimba, Contrave
If you’re looking for a modern medication to help reduce appetite, a combination of naltrexone and bupropion may be the right choice. In European Union countries, the medication Mysimba is registered, while in the USA, your doctor would prescribe Contrave. Both medications require a prescription. [5]
How does naltrexone-bupropion work?
Mysimba and Contrave target the central nervous system directly – the brain. They influence neurotransmitters, which are substances that transmit information between nerve cells. By affecting these messengers, they can decrease appetite and increase feelings of fullness. Better control of appetite ensures lower calorie intake.
What if someone struggles with emotional eating? Interestingly, even in this case, these medications can lend a helping hand. They block the reward system in the brain, where dopamine plays a key role. Dopamine is responsible for the pleasure from eating and feelings of bliss that follow indulging in a favorite treat. However, when this system is dampened, the body isn’t as drawn to tasty food. Mysimba and Contrave can not only reduce hunger and promote satiety but also help control cravings and the uncontrollable urge to snack. [19]
Is naltrexone-bupropion effective?
The active ingredients naltrexone and bupropion have shown effects on body weight even when taken separately. However, clinical studies have confirmed they are more effective when used together. Results from a study involving 419 participants indicate that after 48 weeks, there was an average weight loss of 6%. [2]
Does naltrexone-bupropion have side effects?
Even in this case, adverse effects relate to digestion. Nausea, vomiting, or constipation may occur. Dizziness or dry mouth are also known side effects. Increased blood pressure, higher heart rate, or insomnia are not uncommon among those taking these medications. [19]
3. Liraglutide – Saxenda
Liraglutide belongs to the newer and more modern substances in the world of anti-obesity medications. It has only been on the market since 2015, known in the European Union and the United States under the commercial name Saxenda. However, its method of administration might deter some. Unlike previous medications, it is not taken in tablet form but administered once daily by injection under the skin. [10,24]
How does liraglutide work?
Liraglutide mimics the action of glucagon-like peptide-1 (GLP-1), a hormone naturally secreted in the digestive system. Similar to GLP-1, liraglutide influences parts of the brain that control appetite, reducing hunger and increasing feelings of fullness. It also slows down gastric emptying, leading to lower caloric intake and weight loss. [24]
Saxenda primarily acts as an antidiabetic medication for people suffering from type 2 diabetes, helping to increase insulin secretion, which aims to lower blood sugar levels.[24]
Is liraglutide effective?
Saxenda is now among the most popular anti-obesity medications, and for good reason. Clinical studies focusing on this medication show that it helps reduce caloric intake by approximately 16%. With a daily intake of 2000 kcal, this translates to about 320 kcal saved. Considering the fact that the recommended caloric deficit is around 500 kcal, the remaining 180 kcal can quite easily be burned through walking or strength training. [11]
In five studies involving around 6000 individuals, it was found that on average, participants lost 8% of their body weight (after about 40 weeks of use). Scientists also concluded that liraglutide use in people with obesity reduces the risk of developing type 2 diabetes by up to 80%. [11,24]
Does liraglutide have side effects?
Like practically any medication, liraglutide is not exempt from side effects. Digestive problems such as constipation, diarrhea, vomiting, or nausea are common. [24]
4. Semaglutide – Ozempic, Wegovy, Rybelsus
Semaglutide is perhaps the most widely known medication for weight loss today. It is hidden behind the well-known brands Ozempic and Wegovy, which boast about their effects throughout Hollywood. Alternatively, you might encounter it in the form of the medication Rybelsus.
However, it is primarily a substance belonging to antidiabetic medications. Rybelsus and Ozempic should be correctly prescribed only to diabetics. The effect on weight loss became apparent over time, leading to the development of Wegovy, which can be prescribed for obesity treatment.
Semaglutide has gained popularity due to its rapid effects and perhaps its method of administration. To experience its effects, you only need to inject it once a week into your abdomen or thigh. In this case, it seems like waving a magic wand and achieving the desired figure is within reach. But not so fast. Even with Ozempic, not everything is as perfect as it seems.
How does semaglutide work?
Semaglutide acts similarly to the previous liraglutide. It also mimics the hormone GLP-1, reducing hunger and promoting satiety, and its impact on slowing gastric emptying is crucial. Its advantage lies in the gradual release in the body, with one dose being processed over a longer period. This is why it only needs to be taken once a week. [6,23]
However, semaglutide is primarily intended for the treatment of type 2 diabetes, effectively helping to lower and stabilize blood sugar levels.
Is semaglutide effective?
Semaglutide isn’t just praised in the media; good results also stem from clinical studies. Research involving people with obesity who took semaglutide for 68 weeks showed an average weight loss of 17%. Alongside this, health parameters such as blood lipid levels or glycemia also improved. [12]
So what takes precedence? Diabetes or weight loss? When news spread that it helps shed pounds quickly, especially in North America, there was a rush for semaglutide. This led to a problem because diabetics started to miss out. In practice, when you start using a diabetes medication for weight loss without control, there can easily be a shortage on the market. Ozempic or Wegovy have demonstrable effects on weight loss, but primarily, their undeniable benefits should be reaped by those who truly need them for their health problems.
Does semaglutide have side effects?
When taking semaglutide, digestive problems such as constipation, vomiting, and nausea are the main concerns. If you’ve followed the media frenzy, you might have noticed that many celebrities also spoke about fatigue, dizziness, or increased sensitivity and moodiness. [23]
What other weight loss medications do we know?
- Phentermine-topiramate may be familiar to you under the brand name Adipex Retard. It acts on the brain’s centers, effectively suppressing appetite. It was used for a long time in obesity therapy, but the European Medicines Agency recently banned it due to the risk of dependence and frequent side effects.
- Tirzepatide is the active ingredient in the medication Mounjaro. Like semaglutide and liraglutide, it mimics the function of the GLP-1 hormone. [18]
- Setmelanotide, known as the medication Imcivree, is used to treat genetically caused obesity. [17]
Who are weight loss medications intended for?
You might have thought that these pills and other weight loss medications could be the solution to the global problem of increasing overweight and obesity. If they were available to everyone, more people would successfully lose weight, there would be fewer cases of diabetes, and other metabolic diseases.
We might even be able to lighten the load on healthcare systems and state budgets, which deifnitely doesn’t sound like a bad thing. After all, data from 2023 shows how easily, for example, average annual expenses for treating diabetes, ischemic heart disease, and myocardial infarction could be reduced in Germany. Simply lowering the BMI from 30 kg/m2 by just one unit could save an average of about 4300 euros annually. Weight loss medications could easily help with that, right? It sounds like a fairy tale, but in reality, it’s not that simple. [3]
Are they also suitable for healthy people?
If there were a possibility to prescribe weight loss pills to absolutely everyone, we would be getting closer to that fairy tale. In reality, healthy people with just a few extra pounds of fat can actually harm themselves with weight loss medications. The risks simply outweigh the benefits. Just think of the side effects of Ozempic and other substances we’ve discussed.
While these medications can help with weight loss, to be healthy, especially in the long term, you primarily need to adhere to a healthy lifestyle in all its aspects. Weight loss medications can never replace a healthy diet, sleep, or regular exercise.
Ultimately, we must also realize that these are medications. Just like heart or asthma medications, they are intended for people with health problems. Even the term “anti-obesity” indicates that they should be taken by people diagnosed with obesity, a condition that often comes with various complications. They are the final piece of the puzzle that comes into play when lifestyle changes alone fail to result in weight loss.
The main goal of anti-obesity medications is not aesthetics and perfecting one’s body, but rather getting rid of health complications associated with excess body weight. Obesity typically leads to high blood pressure, cholesterol, and other complications, which are direct tickets to a world full of strokes and heart attacks.
Officially, weight loss medications should be prescribed only in the following cases:
- For people with obesity (BMI higher than 30 kg/m2).
- For overweight people with a BMI over 27 kg/m2 who already suffer from conditions caused by excess weight (high blood pressure, atherosclerosis, or other cardiovascular problems, diabetes, etc.). [14]
Is simply taking medications enough when you need to lose weight?
Let’s imagine you want to lose weight and meet the conditions for medication prescription. Will you be saved by taking one pill every morning from now on? It would be great if you could shed unwanted pounds by simply taking pills while washing them down with Coca-Cola and eating pizza. Unfortunately, we don’t live in a dream world, and it simply doesn’t work like that.
In this case, too, it holds true that to lose weight, you need to adjust your lifestyle first. Weight loss pills are not omnipotent and ideally should only complement a weight loss diet, regular physical activity, and other aspects of a healthy lifestyle. Saxenda, Ozempic, and other medications should always come into play as a last resort, only to enhance and accelerate weight loss.
Not only will you lose weight more easily and significantly improve your health, but you will also significantly increase the chance of maintaining weight loss even after discontinuing the medications.
Because if you rely solely on medications, you’ll likely lose weight, but what happens after you stop taking them? When you no longer have this crutch, the pounds of fat will sooner or later come back, probably with interest. Weight loss medications are not exempt from the old familiar yo-yo effect.
Who should avoid weight loss medications?
Every medication has its specifics, but generally speaking, these medications should not be prescribed in the following cases:
- For pregnant and breastfeeding women.
- In most cases, for children, although a doctor may decide on exceptions.
- For people with eating disorders (EDs) or other psychiatric diagnoses.
- In the presence of various illnesses. However, these cases are very individual for each medication, and it’s up to the doctor whether to prescribe the medication or not.
Can weight loss medications interact with other drugs?
Every medication becomes part of numerous physiological processes in the body. Therefore, it’s very likely that some of them will cross paths and interfere with each other. The likelihood increases with the number of medications a person takes. Weight loss medications are no exception, and there are many possible interactions. It’s primarily up to doctors to ensure that the individual medications a person takes do not interfere with each other.
An example of such an interaction is orlistat, which can reduce the absorption of epilepsy medications. Furthermore, when combined with warfarin (a blood thinner), it can increase bleeding. [22]
What is the ideal approach to taking weight loss medications?
No medication is a miracle that will save us on its own and cure obesity. In any case, it’s important to start with lifestyle changes. Set up a reduction diet, choose appropriate regular physical activity, address sleep problems, and control stress. Only then should medications be considered. How long to take them depends mainly on how successful the weight loss is and at what weight the weight loss starts.
How do medications differ from weight loss supplements?
You surely know that there are not only medications but also weight loss supplements promising getting rid of excess water, weight control, and other great benefits. As examples we can mention Forfemina, Lipoxal, Diterpex, or Bellasin.
How do these supplements differ from medications besides the fact that you can buy them right now without any prescription from a doctor? The main and most important difference is their effectiveness. Weight loss supplements have not undergone clinical trials. Unlike medications, they have come to the market without professional organizations confirming their efficacy.
What should you remember?
When the media filled with information about Hollywood stars losing weight at lightning speed thanks to Ozempic and Wegovy (semaglutide), the world was excited about the idea of easy weight loss and the end of endless dieting. And actually, somewhat rightfully so, because weight loss medications are no charlatanism and really work. Nevertheless, every enchanting tale harbors a twist, and this scenario is no exception.
Weight loss medications are simply medications, so they are not intended for healthy people. They should be given to those with health problems, namely people with obesity and associated complications. For healthy people with a few extra pounds, they are more risky than beneficial. Even amidst the advancements of modern medicine, the cornerstone of weight loss remains a caloric deficit rooted in a balanced lifestyle.
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[11] ROUX, C.W. LE et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. – https://pubmed.ncbi.nlm.nih.gov/28237263/
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[16] Hollywood’s new secret to losing weight is a diabetes injection. – https://nypost.com/2022/10/11/hollywoods-new-secret-to-losing-weight-is-a-diabetes-injection/
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[19] Mysimba | European Medicines Agency. – https://www.ema.europa.eu/en/medicines/human/EPAR/mysimba
[20] Oprah Winfrey’s revelation about using weight loss drugs is a game changer. Here’s why. In USA TODAY – https://www.usatoday.com/story/life/health-wellness/2023/12/14/oprah-ozempic-weight-loss-drugs-cultural-impact/71913261007/
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[24] Saxenda | European Medicines Agency. – https://www.ema.europa.eu/en/medicines/human/EPAR/saxenda
[25] Sharon Osbourne defends Ozempic usage despite now weighing “under 100 lbs”: “I don’t regret it”. – https://nypost.com/2024/01/16/entertainment/sharon-osbourne-defends-ozempic-usage-despite-now-weighing-under-100-lbs-i-dont-regret-it/
[26] What has Oprah Winfrey said about taking weight loss drugs? Here’s what to know. In TODAY.com – https://www.today.com/health/diet-fitness/oprah-winfrey-weight-loss-drug-rcna128714
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