Weight loss Medications

Here are a few medicine options with their pros, cons, effectiveness, and costs.

Phentermine

This is a great option. We find that is a very effective appetite suppressant. We can usually find a coupon to get it for $12- $15/month. It is classified as a stimulant, it is a controlled substance by the DEA. We, therefore, require in-person visits to prescribe this medication. Also, because it is a stimulant, we don’t love it in patients that have problems with anxiety, as it can make that worse. We obviously do not use this during pregnancy. Some people see some constipation, so we often recommend a fiber supplement (which also helps with cholesterol). It is an appetite suppressant, so the main problem we see is that people take the pill, keep over-eating and don’t lose weight. The medicine helps, but it does not burn calories off of you. If you don’t eat less and burn more calories, you won’t lose anything, even in medicine. There are several other contraindications and issues, which is why it is a prescription medication. If and your doctor agrees that it is a good idea for you, they will work through those. Overall, phentermine is our #1 option but has the downside of requiring an in-person office visit. Phentermine is also sold as a combination drug with topiramate (see below) in a lower dose. As the combo pill is a newer medication, the price is 20x the price of phentermine alone, but no more efficacious.

Topiramate (generic Topamax)

Originally, this medicine was marketed as a migraine medication and was sometimes used for seizures. But, as it works your brain, it also happens to interact with the parts of the brain that work on appetite. Again, it is an appetite suppressant, so it works by helping you eat fewer calories. This medicine should not be stopped quickly, a doctor should help you wean off slowly. Women on topiramate should be on reliable contraception as there is some research that suggests that topiramate can increase the chance that an infant can develop cleft palate or similar diseases if the mother is on topiramate when she gets pregnant. There are several other contraindications and issues, which is why it is a prescription medication. If and your doctor agrees that it is a good idea for you, they will work through those. Though the combination has not been evaluated by the FDA, it seems reasonable that combining generic topiramate and generic phentermine would work the same as the pill that is sold with them combined. But, as no one is going to make money answering that question, we will likely never know for sure. We believe that combining the two in a low dose is appropriate for many patients. It costs about $0.04/day.

Bupropion (generic Wellbutrin)

Bupropion is a fairly effective medication that has a role, especially in patients that also have depression or desire to quit smoking (it originally came out as an antidepressant and it makes you not want to smoke too!). Like the other medicines, it is an appetite suppressant, so it helps by helping you eat less. It also should not be taken during pregnancy. It cannot be taken by people with seizure disorders. In general, it is not as effective as phentermine but has few side effects. It costs about $0.25/day

Diet and Exercise

We recommend an 800-1,200 calorie diet. Research shows that everyone will lose weight at this level and going below 800 calories does not speed up the process. There is no definitive answer to questions as to which type of diet is best. We believe the best diet is the one that you can follow, and follow forever. Remember, if you lose weight and then start eating excessive calories again, you will gain it all back, and usually more. Though exercise is less important than dieting, it is still important. We recommend whatever you like to do that gets your heart rate elevated and target 150 min/week, or more. It cannot be overemphasized that eating fewer calories is what makes you lose weight. We frequently talk to people who believe that “it doesn’t work for me.” When we have them count calories, they are always over. We can help some with medicine, but the way the medicine works is by helping you eat less.