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Weight loss pills: Who can benefit, side effects of weight loss drugs

ByZarafshan Shiraz, Delhi
Jan 13, 2023 10:49 AM IST

Most people who need to lose weight go through very difficult and demotivating journeys where diet and lifestyle modification alone usually falls short as a treatment option. Here's all you need to know about weight loss pills, who can benefit from them and side effects of these drugs

If there is one thing that millions in this world would wish for, it would be weight loss in a pill and for decades, scientists have been trying to crack the obesity code but success has eluded them at every juncture. Most people who need to lose weight go through very difficult and demotivating journeys where diet and lifestyle modification alone usually falls short as a treatment option.

Weight loss pills: Who can benefit, side effects of weight loss drugs (Gustavo Fring)
Weight loss pills: Who can benefit, side effects of weight loss drugs (Gustavo Fring)

Most people do well when they are in the program but it is not possible to be on a diet forever. At the other end of the spectrum, we have the option of bariatric surgery however, not everyone is eligible for surgical treatment of obesity.

As per the guidelines of the Obesity and Metabolic Surgery Society of India (OSSI), a person with a BMI 35 Kg/m2 without any co-morbidities or a person with a BMI 30 Kg/m2 with any two co-morbidities like diabetes, hypertension, sleep apnoea etc can be considered for surgery. There is still a huge treatment gap when it comes to people who fall into the categories of grade 1 or 2 obesity.

In an interview with HT Lifestyle, Dr Aparna Govil Bhasker, Bariatric and Laparoscopic surgeon at Saifee, Apollo Spectra, Namaha and Currae Hospitals in Mumbai, explained, “Most often, lifestyle and dietary interventions fall short of meeting patients and clinicians’ expectations of weight loss targets. It is said that eight out of ten people need some additional intervention for significant weight loss and weight maintenance. Till recently, we had only one drug in India that was approved for weight loss - Orlistat. Years of experience have shown that orlistat has only modest results on weight loss and has not been very effective for the Indian population.”

According to Dr Aparna Govil Bhasker, in the last few years, the research for weight loss drugs has gained momentum. There are many weight-loss drugs that have been approved by the FDA and a few are in the pipeline. Some of the FDA approved drugs are listed below:

● Orlistat

● Phentermine with topiramate- commonly known as “Qsymia”

● Naltrexone with bupropion- commonly known as “Contrave”

● Liraglutide- commonly known as “Victoza”

● Semaglutide- 2.4 mg commonly known as “Ozempic or WeGovy”

Dr Aparna Govil Bhasker pointed out that out of these drugs, presently orlistat and liraglutide are approved as weight loss drugs for use in India. Talking about weight loss outcomes of these drugs, she revealed, “The current lot of weight loss medications may lead to a total body weight loss of 5 to 10% when used in combination with diet and lifestyle modification. 10% total body weight loss is quite effective for improvement in metabolic health in terms of better control of diabetes, hypertension, dyslipidaemia etc that may be associated with obesity. Up to 10% total body weight loss is also considered to be beneficial for diabetes related end-points and helps to delay related complications in future.”

Sharing information on who can benefit from weight loss drugs, the health expert said, “People who are overweight and have grade 1 obesity can benefit from weight loss medications in conjunction with diet and lifestyle modification. However, all weight loss medications are prescription drugs and self-medication must be avoided. These drugs can also be used to help patients who regain weight after a few years of bariatric surgery. They may be used for patients who are medically unfit for bariatric surgery.”

She added, “It must be remembered that weight loss drugs are not a cure for obesity but help to keep it under control. Every patient responds differently to medications and weight regain is a high possibility after the drugs are discontinued. Hence it is extremely important to embrace a healthy lifestyle which can be of help for weight maintenance after the drugs are discontinued.”

As per Dr Aparna Govil Bhasker, the side effects of weight loss drugs are as follows:

● Orlistat - Leads to weight loss by causing mal-absorption of fat. It can lead to bothersome gastrointestinal side effects, such as flatulence and loose stools.

● Bupropion-naltrexone - This drug carries a warning about suicide risk. It can also lead to high blood pressure, nausea, headache and constipation. Presently it is not approved for weight loss in India.

● Liraglutide/Semaglutide - Can lead to nausea, vomiting and other gastro-intestinal side effects in the initial days.

● Phentermine-topiramate - Phentermine has the potential to be abused because it acts like an amphetamine. It may lead to an increase in heart rate and blood pressure, insomnia, constipation, and nervousness. Topiramate may increase the risk of birth defects.

As the incidence of obesity continues to rise unabated all across the world, Dr Aparna Govil Bhasker said, “The research efforts to beat obesity have also been increased manifold. There are some promising drugs that are under development currently. Tirzepatide and Cagri-sema are a couple of weight loss medications in the pipeline that will be more effective than the current lot and will hopefully provide some respite from the scourge of obesity. However, only time will tell if these medications will stand the test of time.”

She concluded, “Obesity is a complex and chronic disease. A multi-modality approach is needed for treatment to be effective. Treatment needs to be tailored for individual patients and various permutations and combinations of diet, lifestyle modification, drug therapy and bariatric/metabolic surgery may be needed based on the clinical profile of the patients. The newer drugs are promising and will have an important role to play in the management of obesity.”

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