By Dr. Alok Gupta, MD
INDIA New England Health Columnist
Nearly 38% of the US population is obese, defined as a body mass index (BMI) greater than or equal to 30kg/m2. Obesity can lead to many health problems including diabetes, high blood pressure, sleep apnea, depression, infertility and an increased incidence of certain cancers. Needless to say obesity can be a significant health and financial burden for the individual and society as a whole. In 2008, the cost of treating obesity in the US was $147 billion, with obese patients occurring $1,429 more in medical costs that year than their non-obese counterparts.
Many obese patients have tried a variety of diets and exercise regimens with varying degrees of success. Some may be able to maintain restrictive diets for long enough to achieve significant weight loss, however many regain some or all of the weight lost. Few are able to maintain a healthy weight. Even weight loss achieved after bariatric surgery can be regained if a patient “self-reverses” these surgeries by failing to maintain portion controls prescribed by their surgeons.
Recently four new anti-obesity medications have been approved for use by obese patients and/or overweight patients (BMI >27kg/m2) with complications such as Type 2 Diabetes, high blood pressure, or high cholesterol. The addition of these medication can increase adherence to diet and behavior changes required to maintain weight loss long term. Each of the medications comes with their own set of cautions and side effects, but can be powerful adjuncts to diet and exercise and can be used after weight loss surgery when weight loss plateaus or after surgery failure.
• Lorcaserin, brand name Belviq, is thought to act on brain centers by promoting a feeling of fullness, and decreasing food consumption.
• Qsymia, is a combination of phentermine, an older and well known appetite suppressant, and extended-release topiramate, originally used to treat seizures. The combination suppresses appetite and increases feelings of fullness better than either one alone.
• Contrave, another combination medication, blends naltrexone and bupropion. Bupropion which has been used successfully to treat depression and aide in smoking cessation works by increasing dopamine thereby suppressing appetite. Naltrexone, used previously to prevent relapse of opioid and alcohol use increases the action of bupropion helping to control cravings and overeating.
• Liraglutide first used in the treatment of Type 2 Diabetes as Victoza is used in a higher dose daily injection called Saxenda for weight loss. This medication regulates appetite in the brain and delays stomach emptying, resulting in an increased felling of fullness.
While there is no replacement for healthy diet with appropriate calorie requirements, these newly approved medications can help with some of the struggles patients face when trying to lose weight. These medications can have side effects and may not be used by those with certain medical conditions. Please consult with your healthcare provider to determine which medication may be right for you.
Editor’s note: This article is only for informational purposes. For any medical issues, please consult your own physician.
(Dr. Alok K. Gupta is an Internist, a doctor for adults. He is a Board Certified in Internal Medicine. He completed his residency in Internal Medicine at Salem Hospital in Salem, Massachusetts. Part of the training was also at Massachusetts General Hospital. Dr. Gupta has been practicing Internal Medicine since 1998. He was in upstate New York for six years. Recently, he had been practicing in Manassas, and now is in practice in Gainesville. Visit him on the web at www.alokguptamd.com )
