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FDA Approved Weight Loss Medication Helps to Achieve & Sustain Healthier, Lower Weights!

FDA Approved Weight Loss Medication Helps to Achieve & Sustain Healthier, Lower Weights!

FDA Approved Weight Loss Medication Helps to Achieve & Sustain Healthier, Lower Weights!

 

Background: Using FDA approved weight loss medication in combination with lifestyle changes to achieve and sustain better results.

 

Let’s face it, losing weight and equally importantly, sustaining your healthier, lower weight once
you get there, isn’t easy. While we believe healthy lifestyle changes and behaviors are critical, central components of any sustainable weight loss and health journey, in the 21st century, we additionally believe that FDA approved weight loss medications can also complement those efforts to help people achieve and sustain even healthier, lower weights in a way that people without the support of complementary medications may not.

 

Lifestyle Changes Combined with Medications
Going there (to medication assistance) is okay. It’s not a crutch, it’s not a (personal) failure of
any kind, and nor is it unsafe. To the contrary, a lower and healthier weight may not only help
you feel better and more confident but be metabolically much safer for you in the long-run. If
lifestyle changes combined with medications helps you achieve such better and sustained
outcomes, well, frankly, God bless them and the clinicians skilled in finding and tailoring the
right pharmacologic regimen – just for you.

 

What can medications do to help? Several things
For one, they can positively influence “behavior.” Why does that matter? Well, biology
drives behavior through a complex web of (negative) “feedback loops” between hunger and
satiety signals between the hunger center in the brain, the gut, and one’s fat cells. Each of
those hunger and satiety signaling loops represent potential therapeutic targets wherein a
given medication or better yet medications can combat hunger and cravings and promote
satiety from one or several different angles.

 

FDA Approved Weight Loss Medication Helps You “say no” to Temptations
What does that do practically? It helps you “say no” to temptations such as refine
carbohydrates, to better manage afternoon or evening cravings or stressful moments, and to
feel more comfortable consuming a portion controlled, lower caloric intake that promotes
weight loss.

 

Break Free from those Hormonally Induced Hunger & Cravings
It means that when any of the 8 or more hunger hormones modified by your brain in
response to significant weight loss (over, let’s say, 10% of body weight) in ways that
increase appetite and encourage regain (not fair!), we can help short-circuit some of
those saboteurs. What can that achieve? Well, it can help you break free from those
hormonally induced hunger and cravings, slowing or plateauing of weight loss when you’re
short of your goal, or downstream regain on maintenance.

 

Medications Help Drive Other Hormonal or Other Changes
They can also help drive other hormonal or other changes that work “behind the scenes” to
facilitate fat burning, improve one’s metabolic rate, combat fat accumulation, excrete
carbohydrate, boost muscle mass, and more. All of these elements can combine to help you achieve and sustain your health and wellness goals.

 

Achieve & Sustain Better Outcomes than Lifestyle Changes Alone
In summary, if combining healthy lifestyle changes with FDA approved weight loss medication helps you
achieve and sustain better outcomes than lifestyle changes alone, let’s use every tool
we can in the modern age to help you. Before listing out some of the medication options available to assist you on your journey, a couple clarifying points.

 

Off-label FDA Approved Weight Loss Medications
Sometimes we will use medications that are FDA approved for another purpose or
indication other than weight loss. That’s known as “off-label” prescribing of medication. It’s a
common and legal practice (about 21% of medication prescriptions are considered “off-label”) and very helpful for us as it gives us additional options and angles by which to help you achieve and sustain better results.

 

Combination therapy versus monotherapy
When it comes to weight loss, in the end “combination therapy” (where we prescribe
more than one medication) is more effective than “monotherapy” (where we prescribe a
single medication). What does more effective mean? It means we can help you achieve better
results with a lower side effect profile by combining medications and combatting the
aforementioned complex web of hunger and craving signals from different angles. So, don’t
be surprised if early or later in your journey we recommend anywhere from one to multiple medications to achieve and sustain your goals.

 

Prior FDA authorization
Some of the medications noted below are generic and thus relatively inexpensive. Others
are new generation medications that can be quite expensive (i.e. GLP-1’s can range from
$800 to $1400 / month without help from insurance). For the more expensive meds (and
even the generics with your blessing), we will use a tech enabled home delivery
pharmacy called AltoMD to help obtain “prior authorization” from your insurance company to help subsidize the costs of FDA approved weight loss medications approved by your insurance (“on formulary”). AltoMD is also quite effective at applying discount coupons to specialty medications and lower costs on generic medications, all to provide better medication pricing for our customers.

 

Tailoring your medication list
One other thing your clinician may do is to explore whether certain weight positive (weight
gaining) medications prescribed to you by outside doctors might be stopped or substituted for
other medications that are weight

FDA Approved Weight Loss Medication Options:

 

Buproprion (Wellbutrin or Zyban)

  • Buproprion is an anti-depressant and smoking cessation medication that helps promote

weight loss (and unlike many anti-depressants that promote weight gain)

  • Like the sympathomimetic medications noted above, it influences neurotransmitters

(dopamine, norepinephrine and, to a lesser degree, serotonin and POMC) in the hunger

center of the brain to reduce hunger

  • Pharmaceutical companies combined buproprion with naltrexone to create the FDA

approved weight loss medication, Contrave (buproprion + naltrexone).

  • We may either prescribe Contrave or prescribe one or both of the two generic medications

buproprion and / or naltrexone to help you achieve your weight loss goals.

 

Glucagon-Like Peptide 1 (GLP-1) “Agonists”

  • Semaglutide / Ozempic, Dulaglutide / Trulicity, Exenatide / Byetta (weekly dosing)
  • Liraglutide / Saxenda (daily dosing)

o GLP-1 agonists are medications FDA approved for diabetes treatment that we use “off-label” for weight loss in both diabetics AND non-diabetics because they work well

for weight loss and also have dual benefits of improving blood sugar control,

reducing cardiovascular disease risk, protecting kidney function, and more

o Glucagon-like peptides are naturally occurring substances in the body released in

response to food intake to help control blood sugars. They also delay emptying of the

stomach and influence key hunger hormones (leptin) to promote satiety.

o Because they are injectable medications, we prefer the once-weekly versions

prescribed “off-label” for weight loss. While in June we anticipate potential FDA approval for a weekly GLP-1 agonist for weight loss, the only GLP-1 agonist currrently FDA approved for weight

loss is Saxenda (liraglutide) but it is a daily injection.

 

Metformin Extended Release (ER)

  • Like the 2 classes of medications noted above, metformin is also approved for type II

diabetes treatment. Again, we use it “off-label” because studies show it promotes weight

loss (true for both diabetics and non-diabetics)

  • Metformin has an abundance of additional benefits worth mentioning

o It can delay the progression to type II diabetes (from pre-diabetes or metabolic

syndrome) in adults (yay)

o Preliminary data also suggest it may promote longevity and diminish cancer risk

and cognitive decline as we age.

  • Metformin works by improving insulin sensitivity (good for weight loss), decreasing glucose

production and absorption, increasing uptake and use of glucose by muscles, and (may)

lower appetite.

  • We use the extended release 500 mg version almost exclusively as it is inexpensive,

single day dosing, and the extended release version is better tolerated.

 

Naltrexone

  • Naltrexone is another generic medication often used to treat cravings for alcohol

and opioid medication and helpful to diminish cravings and hunger for food as well.

As noted above, the combination of Naltrexone and buproprion can also be

prescribed as the FDA approved weight loss medication, Contrave.

Sodium Glucose Co-Transporter 2 Inhibitors (SGLT2 Inhibitors)

  • Canagliflozin / Invokana, Dapagliflozin / Farxiga, Empagliflozin / Jardiance,

Ertugliflozin / Steglatro

  • SGLT2 inhibitors like Invokana are also approved for type II diabetes treatment and have

dual benefits of promoting weight loss in both diabetics AND non—diabetics (“offlabel” again) in addition to having benefits for improving glycemic control and

cardiovascular risk reduction.

  • These medications work by increasing excretion of anywhere from 60 to 100 grams of

carbohydrate per day through the kidneys, are typically well-tolerated and once a day

dosing.

 

“Sympathomimetics”:

  • Phentermine
  • Phendimetrazine
  • Diethylproprion

o These 3 medications work by modifying neurotransmitters, primarily “norepinephrine,”

in the hunger center of the brain and, in so doing help suppress hunger and cravings.

o They are mild stimulants but generally better at appetite suppression than stimulation

o They are all generic (and relatively inexpensive as such), and typically quite well

tolerated.

o Phendimetrazine and diethylproprion have a shorter duration of action than phentermine so we generally use more of the latter but speak with your clinician to see which one(s) might work best for you.

 

Topiramate (Topamax)

  • Topiramate is an anti-seizure, anti-migraine medication that also drives weight loss.
  • It’s mechanism of action is poorly understood but likely stimulates neurotransmitters in the

hunger center of the brain (GABA) to lower appetite

  • The FDA approved weight loss medication Qsymia is a combination of topiramate and

phentermine. So, we will commonly prescribe those two generic medications together in a way that is complementary and helps to improve and sustain superior and healthier outcomes.

 

Contrave (buproprion + naltrexone)

  • See above sections under buproprion and naltrexone

Qsymia (phentermine + topirmate)

  • See above sections under phentermine and topiramate

Other FDA Approved Weight Loss Medications that can Help Facilitate Weight Loss & Metabolic Health

 

Bioidentical Hormones:

  • Testosterone (and DHEA)

o Testosterone tends to decline as we age. Low testosterone leads to obesity.

o To make matters worse, obesity leads to low testosterone

o This creates a vicious cycle through multiple pathways

o Testosterone replacement decreases fat mass (and increases metabolically healthy

muscle mass) and can complement diet induced weight loss and break the vicious

cycle noted above

o DHEA is a testosterone like hormone (and testosterone precursor) often prescribed in

combination with testosterone to optimize treatment of low testosterone

 

  • Estrogen / estradiol

o Both menopause and even peri-menopause involve reductions in estrogen / estradiol

levels.

o That’s problematic for weight control because estrogen help control body weight and

metabolism (a decreased in estrogen lowers metabolism)

o Lowering of estrogen also changes fat cells sensitivity to insulin in a weight that

promotes accumulation of fat around the mid-section and buttocks in addition to

promoting weight gain

o Properly delivered estrogen / estradiol replacement can complement weight loss

efforts and counter the menopausal tendency to gain weight and redistribute fat to the mid-section and buttock areas.

 

  • Thyroid

o Thyroid is the principle metabolic quarterback in the body

o Low thyroid (even low normal thyroid) negatively impacts our metabolic rate and ability

to burn fat

o High normal youthful levels of active thyroid hormone facilitate weight loss, fat burning

(or “oxidation”) and prevention of weight gain.

 

***Note: Further information on FDA approved medication usage to achieve and sustain

weight loss (and health) outcomes at JumpstartMD also available on Dr. Bourke’s

recorded health webinar stored on member portal and dated June 18th, 2020

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