Gone are the days of battling obesity with a limited toolbox. With more weight loss supplements and drugs on the market than ever before, deciding which medication is right for you isn’t as simple as picking the most popular name or the one linked to the most weight loss.
From older oral medications to newer injectable options like Wegovy and Zepbound — drugs that have taken the weight loss market by storm — each treatment option comes with its own benefits, side effects and cost considerations. Deciding which one is right for you means weighing these factors alongside your personal medical history,insurance coverage and how your body responds to treatment.
Here’s what to know about navigating the available weight loss drug options, and how to choose one that aligns with your health and long-term goals.
What Are Weight Loss Drugs?
Though the term “weight loss drugs” has become popular, particularly in the age of social media, the more accurate term is weight management drugs or obesity drugs — “just like we would say that these are cancer drugs or diabetes drugs,” says Dr. W. Scott Butsch, director of obesity medicine in the Bariatric and Metabolic Institute at Cleveland Clinic in Ohio.
As with other chronic conditions, medications can be used to help manage obesity. Weight management drugs work in a variety of ways, from reducing appetite and decreasing fat absorption from foods, to mimicking your body’s natural hormones to slow the movement of food through the stomach.
Medications are just one tool for treating or managing overweight and obesity. Your health care provider may also recommend lifestyle changes or procedures known as bariatric surgeries, either as an alternative to medication or alongside it.
[READ: How to Calculate Weight Loss Percentage.]
Types of Weight Loss Drugs
The Food and Drug Administration has approved several medications for chronic weight management. Below, compare different types of weight management drugs, how and when they’re administered and how they work.
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Weight management medications should be used in combination with lifestyle changes, including following a well-balanced, reduced-calorie diet and increasing physical activity.
[Read: What Happens When You Stop Taking Weight Loss Drugs?]
Comparing Weight Loss Medications
Older weight management drugs generally produce less weight loss compared with more recently approved drugs, which have demonstrated greater effectiveness in clinical studies.
Older weight loss drugs:
— Phentermine-topiramate (Qsymia)
— Naltrexone-bupropion (Contrave)
— Orlistat (Xenical, Alli)
— Liraglutide (Saxenda)
Recently approved weight loss medications:
— Semaglutide (Wegovy).
— Tirzepatide (Zepbound)
At the lower end of the spectrum are simple appetite suppressants, including the oral medication phentermine-topiramate, says Dr. Mir Ali, a board-certified general surgeon, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. “What they do is make the patient feel less hungry.”
Similarly, naltrexone-bupropion is an oral medication that reduces cravings and suppresses the appetite.
Another medication that’s been around for more than 20 years with “modest success” is orlistat, which blocks fat absorption in the intestines, Ali says. However, he notes it’s not prescribed as often because most patients dislike its common side effects, such as diarrhea.
Liraglutide, an injectable form of GLP-1 medication, is somewhat more effective than oral medication options, Ali says.
However, newer weight management medications have shifted the landscape of obesity treatment.
GLP-1 receptor agonists like semaglutide — marketed as Wegovy for weight management and Ozempic for diabetes — work by targeting the body’s GLP-1 receptor, which helps suppress the appetite and affects the gastrointestinal tract.
“It slows down the emptying of the GI tract, in particular the stomach, so people feel full for longer,” Ali says. This injectable medication has “better results” than oral medications, he adds.
The newest medication to hit the market is tirzepatide — marketed as Zepbound for weight management and Mounjaro for diabetes.
Tirzepatide works on two receptors: GLP-1 and GIP.
“Both are involved in suppressing the appetite and slowing the empty of the GI tract,” Ali says. Because it targets both receptors, “it’s a little bit more effective than just the semaglutide.”
These advancements have transformed the way doctors approach weight management today.
This whole method of decision-making has really changed in the last three to four years because of the new long-acting GLP-1 agonists and their effectiveness, Butsch says. Prior to 2021, most obesity medications were “about the same,” he adds, where you were looking at around 3% to 9% body weight loss in clinical trials.
Newer medications have demonstrated a higher percentage of weight loss. In clinical trials, semaglutide (Wegovy) led to an average weight loss of about 10% to 15% of body weight. And tirzepatide (Zepbound) showed even greater results, with some losing up to 20% or more of body weight.
[READ Side Effects of the New Weight Loss Drugs: Are They Safe?]
Which Weight Loss Drug Is Best for You?
Deciding which weight management drug is best for you requires an individualized approach.
With more severe and complex disease, providers think about surgical and pharmacological therapies, Butsch says. In more straightforward cases, lifestyle interventions often come first and may be combined with medications, he says.
Body mass index — a number calculated from height and weight — isn’t a perfect measure, but it’s a factor that doctors use for determining a treatment strategy and is part of what insurance companies use when deciding whether to approve weight loss treatments.
“If somebody meets the BMI criteria for surgery, that is the best, most effective weight loss method,” Ali says. “If they don’t meet the criteria for surgery or they’re not interested in surgery and their insurance may cover the newer weight loss medications, then we try to put that in for them.”
Choosing the best option is typically a joint decision between a patient and their health care provider, and several factors weigh into the decision:
Severity and complexity of disease
The severity and complexity of a patient’s weight-related health problems play a central role in selecting the right weight management medication. For example, some medications have a certain BMI threshold, meaning some medications shouldn’t be used by people with a BMI below a specific threshold, such as 30 or 35.
Additionally, patients with multiple health conditions — such as diabetes, high blood pressure or heart disease alongside obesity — may require extra considerations when deciding the best medication treatment approach.
Yours and your family’s medical history
Some medications have certain contraindications, meaning health conditions, previous medications or other factors making their use unsafe for some people. Therefore, your doctor will carefully consider your personal and family medical history in the decision-making process to ensure your safety.
For example, during clinical studies, semaglutide and liraglutide injections caused thyroid tumors in rats. Though it’s unknown whether these medications increase the risk in humans, you should tell your doctor if you or anyone in your family has a history of thyroid cancer or a tumor-causing condition called multiple endocrine neoplasia syndrome type 2, or MEN 2. In that case, your doctor will likely avoid prescribing these options.
Medication side effects
Some weight management medications may cause bothersome side effects that disrupt daily life, while others can carry the risk of serious, potentially life-threatening side effects.
“The main side effects of the injectable medications are nausea or GI type side effects, like diarrhea or constipation,” Ali says. More rare side effects include inflammation of the pancreas or gallbladder, he says.
In addition, drug regulators have received some reports of stomach paralysis among patients taking GLP-1 agonist drugs. If someone has a history of slow stomach emptying, such as gastroparesis, experts caution against using the drugs. Many people also experience rapid weight loss on these drugs, which can lead to the loss of lean muscle.
Discuss possible side effects with your doctor to decide which option may be best for you.
After starting on medication, your doctor will also monitor your response closely and may adjust your treatment plan or prescribe an alternative if you’re not tolerating it well.
Cost and access
Weight management medications — especially the newer ones — can be expensive, and they’re often not covered by insurance.
Butsch adds that he has been practicing obesity medicine for more than 20 years, and in that time, obesity medications have rarely been covered. “It’s always been an out-of-pocket expense, for the most part.”
Ultimately, as a result, a major driver in the decision is often whether someone can afford these medications — especially considering the need for long-term use. Oral weight loss medications are usually less expensive.
[READ: Factors That Contribute to Weight Loss and Weight Gain]
Seeing a Doctor for Weight Loss
“It’s really important for patients to realize that there are people who have expertise specifically in obesity,” Butsch says. “We know, like cancer, that there are many different subtypes of obesity,” Butsch says.
For example, some people have genetic forms of obesity caused by mutations in their brain-signaling pathways, while others may develop obesity as a side effect of medications, such as those used to treat certain mental illnesses or high blood pressure.
Obesity medicine specialists bring a comprehensive, nonjudgmental approach to evaluating a person’s weight, health history and lifestyle behaviors.
During an assessment, doctors specializing in obesity medicine also look beyond the number on the scale and typically explore psychological and behavioral factors related to eating.
“Quickly, we pick up nuances of people’s eating behaviors in our assessment,” Butsch explains.
They may ask questions like:
— Are you an emotional eater or more of a frequent snacker?
— Do you skip meals?
— Do you have cravings for certain foods?
— Do you have hunger or fullness cues, or do you lack those?
These insights help your doctor tailor treatment not just to weight loss goals, but to your day-to-day experience and relationship with food and eating.
Diets and weight loss medications
It’s also important to remember that regardless of what pill, procedure or exercises you do, what you choose to eat still plays an important role in weight loss and is an important part of treatment when you’re using GLP-1s. The efficacy of these drugs can be optimized by complementing them with appropriate dietary choices. The right food choices — such as lean proteins, fiber-rich veggies and whole grains, and healthy fats — can also reduce common side effect like bloating and constipation.
[READ: Exercising on GLP-1s: How to Stay Safe and Healthy]
Weight Loss Drugs and Long-Term Success
When treating obesity, success isn’t all about losing weight. While the scale may offer one indicator of progress, it’s not the only — and arguably even the most important — way to determine whether a medication is working. Changes in other factors, such as physical well-being, eating behaviors and overall quality of life, also matter.
Butsch notes several examples of what success might look like:
— Less knee pain
— Better sleep
— More energy
— Feeling lighter or more mobile
“The scale weight is not an accurate assessment of the effectiveness of an obesity therapy in everybody,” Butsch emphasizes. “It shouldn’t be the sole indicator of whether something is working and not working.”
Equally important, he notes, is knowing when to continue therapy for people who respond to it — and when to change course. “If they’re not responding, (we) should probably not continue. We can move on and try something different.”
Ultimately, the goal is to find a treatment plan that helps patients with overweight or obesity feel better, function better and improve their overall, long-term health.
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Prescription Weight Loss Drugs: Types, Side Effects and How to Choose originally appeared on usnews.com
