The Need-to-Know’s about Weight Loss Medications

Since the late 70s, the prevalence of obesity in Canada has multiplied by orders of magnitude. This trend is concerning at the population level. At the individual level, for those who struggle with this disease, it is an even more worrisome trend especially given the connection with chronic health conditions, like diabetes and heart disease and the shorter lifespan associated with high body weight.

More than ever before, weight loss medications offer patients struggling with high body weight the promise of real weight loss success.

At MyLife Bariatrics, we understand the value of these exciting therapies. We offer sleeve surgery as another weight loss option for those who have had limited or temporary success with these medications and in a number of cases offer combination of weight loss medications with surgery to help patients achieve the maximum benefit of long-term sustainable weight loss.

This article explains how these weight loss medications work, what their side effects are, and what are the best practices for treatment.

Why Pharmacotherapy Is Underutilized

Recent Obesity Canada guidelines recommend pharmacotherapy for people with a BMI over 27. However, almost 98% of those who can benefit from weight loss medications are not receiving this type of treatment.

‍

Why is this? Here are some reasons:

Lack of awareness - A large percentage of people, even those who are considering a visit to a bariatric clinic, may not be familiar with the benefits and guidelines associated with obesity medications or pharmacotherapy.

Stigma - Most people believe obesity results because of a person’s lack of willpower when in fact, high body weight is 50-70% associated with one’s genetics and leads to a clear neurophysiologic state that leads to challenges in losing weight and overeating.

Bias toward obesity - Mistakes and prejudices about obesity can influence recommendations and treatment decisions.

Lack of access/funding - Not everyone can access or afford these treatments.

‍

Anti-Obesity Medications (AOMs) and Their Side Effects

Understanding the available treatments is crucial as you continue your weight loss journey. The landscape of obesity pharmacotherapy has undergone significant advancements over the last few decades. As of now, there are 4 approved weight loss medications in Canada. These anti-obesity medications (AOMs) aim to provide long-term treatment for obesity.

‍

Evidence suggests that in addition to lifestyle changes—such as following a healthy diet plan for weight loss—healthcare professionals can prescribe AOMs to treat those suffering from the disease that is obesity. What’s more, now, more than ever, surgeons and medical doctors are working together to combine medical and surgical treatments to achieve the best weight loss results. This section explains how each medication works, its efficacy, and potential side effects.

‍

The landscape of obesity pharmacotherapy has undergone significant advancements over the last few decades.

‍

Orlistat or Xenical

Orlistat is one of the earliest weight management drugs still available in Canada. It works by reducing the absorption of fat in the gut. Orlistat can reduce total body weight between 2-3%.

Notable benefits include mild improvements in blood sugar, blood pressure, and certain cholesterol levels (LDLs) as well as improve one’s constipation.

On the other hand, Orlistat can cause side effects like gastrointestinal upset, lead to diarrhea and stool incontinence and can also reduce the absorption of vitamins and other medications. If you already don’t consume much fat in your diet, the benefits of Orlistat may be minimal.

‍

Naltrexone-bupropion combination or Contrave

Naltrexone-bupropion (Contrave) is a combination of naltrexone used for opioid dependence and bupropion for depression. This medication is particularly beneficial for those prone to significant food cravings and addictions.

Results from clinical trials have demonstrated that patients using this medication experienced an average weight loss of 4-6% within a year, with roughly half of patients lost ~ 5% of their initial weight.

Patients begin the treatment with a daily dose of 8mg of naltrexone and 90mg of bupropion. The dosage is gradually increased to reach the target dose.

Those who use this medication may experience side effects such as nausea, headaches, constipation and dry mouth. This medication is not recommended for you if you have uncontrolled hypertension, have a history of specific eating disorders or seizures, or are pregnant.

‍

Results from clinical trials have demonstrated that patients using this medication experienced an average weight loss of 4-6% within a year, with roughly half of patients lost ~ 5% of their initial weight.

‍

Liraglutide or Saxenda

Liraglutide is part of the new age of weight loss medications that are helping patients achieve success never seen before in obesity medicine.

Saxenda or Liraglutide, is taken once daily via injection to help patients feel full faster, delay gastric emptying and control blood sugar levels.

Data on Saxenda shows that it reduces blood pressure, inflammation levels, improves cholesterol levels, reduces the incidence of type 2 diabetes and the incidence of adverse cardiovascular events.

Data shows that patients can lose between 4-8% total body weight in 1 year. It has long-term benefits, as it helps maintain weight loss over 3 years and can even delay the onset of type 2 diabetes.

‍

Liraglutide however can cause gastrointestinal issues like nausea and constipation, especially during initial dosing. Patients can experience a slowing in gut motility, or gastroparesis or "stomach paralysis".

This typically will resolve when stopping the medications. Rare but serious risks like gallstones and pancreatitis are also associated with its use.

Those who have thyroid conditions or are pregnant may not be cleared to take liraglutide. It's worth noting that, like other weight management medications, stopping liraglutide without maintaining lifestyle changes can lead to loss of weight loss results and weight regain.

‍

Liraglutide however can cause gastrointestinal issues like nausea and constipation, especially during initial dosing. Patients can experience a slowing in gut motility, or gastroparesis or "stomach paralysis" This typically will resolve when stopping the medications.

‍

Semaglutide or Ozempic

Much like Liraglutide, Semaglutide is a GLP receptor agonist. This means that it is a key drug in rebalancing the satiety (feeling full) focus in the part of the brain called the hypothalamus.

Taken via weekly injections it helps patients feel full faster, delay gastric emptying and control blood sugar levels. Semaglutide has shown to achieve an average weight loss of 12% and in 1/3 patients, in industry led studies, has shown 20% total body weight loss.

‍

Stopping Semaglutide without maintaining lifestyle changes can lead to loss of weight loss results and weight regain.

Semaglutide can cause gastrointestinal issues like nausea and constipation. Patients can experience a slowing in gut motility, or gastroparesis or "stomach paralysis"

‍

Stopping Semaglutide without maintaining lifestyle changes can lead to loss of weight loss results and weight regain.

‍

How does Surgery stack up?!

The argument of surgery vs. medications can stop here. No need to argue. Medications make sense for some and surgery makes better sense for others.

Different therapies make more sense at different points in our lives and based on past and current medical history.

Some patients find that the nausea associated with medications is hard to manage. Others find that they plateau earlier than expected with medications and don’t respond. Some patients are excited to see the impact of medications on weight loss but don’t want to take life-long medical therapy.

The impact of surgical weight loss is greater and more sustainable than any other treatment today available in weight loss medicine.

Surgery through sleeve gastrectomy achieves 25-35% total body weight loss or 50-60% excess weight loss.

Surgery comes with complications as well, but we only offer surgery when we feel the benefits outweigh the risks.

Weight regain also occurs after surgery, albeit less common (15-20%), it is still equally important to apply lifestyle changes and have the support of others to reach lifelong results.

Sleeve surgery does not cause gastroparesis and in some instances is used to treat "gastric paralysis". Sleeve surgery, can contribute to de novo, or new reflux after surgery. This occurs on average in 20% of patients. The new reflux typically is treated with anti-reflux medications at first, and with weight loss, it can often resolve. In some patients, where it does not resolve, we can consider conversion to a RYGB.

‍