The pros and cons of weight loss drugs

WASHINGTON — More than one-third of Americans are obese and for some, prescription weight loss drugs may be an option.

Today’s drugs are very different from those in use a generation — or even a decade — ago. Research into the human brain has enabled scientists to come up with new ways to tackle appetite and cravings.

“These are very different,” says Dr. Domenica Rubino, an endocrinologist who heads the Washington Center for Weight Management and Research in Arlington, Virginia.

Since 2012, several new medications have been approved by the Food and Drug Administration that target certain pathways in the brain, a far cry from the amphetamines once used as diet aids.

“So a drug may target dopamine, which is a neurotransmitter in the brain that affects craving and reward behavior,” says Rubino, noting there are also drugs that affect serotonin and other hormones linked to weight control.

But still, despite their safety, these new medications are not for everyone. Rubino says they are best reserved for patients with significant weight to lose who have tried diet and exercise alone and are really struggling.

Sometimes, a strong biological family history of weight can hamper efforts to get down to a healthy number on the scale, as can prescription drugs for various medical conditions that make dropping pounds difficult.

Of course, even the best prescription weight loss drug is not a “magic bullet.”

“You are not prescribed medicine and you take it and you never have to think about it again,” Rubino says. “You still have to make all the lifestyle changes, the nutrition changes, etcetera.”

She says in many cases, these medications make it easier for someone to make those changes. Rubino says as time goes on, it may be determined that these medications can be used not only to lose weight, but to maintain that loss.

“That is the hardest part because your body is really fighting back,” Rubino explains.

She says research shows that even a year after weight loss, hormones are elevated that are really driving appetite, making maintenance a significant challenge.

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