Do you have questions about diet or weight-loss medications? Find the answers in the Mayo Clinic Diet: Weight-Loss Medications Edition, by Donald D. Hensrud, M.D., M.P.H., Andres J. Acosta, M.D., Ph.D., and Tara M. Schmidt, M.Ed., RDN. This book has a strong focus on weight-loss medications, a rapidly changing landscape where reliable facts from a trusted source are key to decision-making. Throughout the book, Mayo Clinic experts answer questions regarding several topics related to diet and weight-loss medications such as in the following excerpt about anti-obesity medication and the future of obesity care.
Anti-obesity medications and the future of obesity care: Questions and answers with Andres J. Acosta, M.D., Ph.D., Internal Medicine
Q: How do current weight-loss medications compare with drugs from the late 1990s, such as fenfluramine-phentermine (“fen-phen”), dexfenfluramine (Redux) and sibutramine (Meridia)? Some of these older drugs, which were approved by the FDA, were recalled because of serious side effects. How safe are the new ones approved for weight loss, such as semaglutide (Wegovy) and phentermine-topiramate (Qsymia)?
A: The newer anti-obesity medications such as semaglutide and phentermine-topiramate have completed a rigorous process guided by the FDA to prove their safety, which is most important and the FDA’s priority. The FDA will continue to monitor anti-obesity medications, as it monitors all medications, for potential side effects not seen in clinical trials. Thus far, in clinical trials and real-world experience, these medications are safe with only rare serious side effects. Common side effects include nausea, vomiting and diarrhea.
Q: There are lots of ads online for alternative weight-loss medications that you can get for much less and without a prescription. Are these just generic versions of the prescription medications? Are they safe to take?
A: The field of nutrition, and especially weight loss, is full of snake oils and baseless offers. Unfortunately, most of them claim to have “evidence,” “science” or “studies.” Be careful. The majority are not evidence based, or their evidence is not well supported. For that reason, our program recommends only medications that use the name, formulation, brand and package recommended by the FDA. There are no generic or compounded versions of these medications.
There are two important reasons to avoid alternative weight-loss medications. First, there is no control of their quality, so you may be spending a lot of money for an untested “water” or “placebo” injection. Second, these alternative drugs may have serious side effects, unknown to the FDA and not reported in studies.
Q: In social media, people are talking a lot about the side effects of Wegovy, Saxenda and other drugs used for weight loss. Are common gastrointestinal side effects simply a part of how these drugs work to help a person lose weight?
A: Unfortunately, yes. These drugs, known as GLP-1 agonists, work by slowing down your stomach and making you feel full. Researchers are trying to figure out whether these two effects are connected or independent. Nonetheless, when you feel overly full, you are likely to feel nauseated and even get sick. These effects are all on the spectrum of fullness and excessive fullness. For that reason, it’s important to eat less to avoid excessive fullness.
Q: Are current weight-loss medications appropriate for people with a BMI lower than 27 and no other conditions?
A: No. The FDA approved these medications for people with a BMI greater than 30 or a BMI greater than 27 with obesity-related diseases, such as diabetes or hypertension.
Q: What happens if you stop taking a prescription weight-loss drug such as Wegovy?
A: The studies have shown that you will likely regain weight if you did not adopt lifestyle changes. For that reason, work with your healthcare team to prevent weight regain if you decide to stop taking medication.
Q: What do you see in the future for obesity care?
A: The future of obesity care is precision medicine for obesity. I see a future in which the right intervention is selected for the right patient, minimizing side effects and optimizing outcomes. Our goal is to reduce trial and error. We have made great progress with our phenotyping approach, but a lot more needs to be done.
An excerpt from Mayo Clinic Diet: Weight-Loss Medications Edition, by Donald D. Hensrud, M.D., M.P.H., Andres J. Acosta, M.D., Ph.D., and Tara M. Schmidt, M.Ed., RDN.
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