Jeffrey Salazar
Doctors may prescribe diet pills to treat obesity or overweight patients with a body mass index (BMI) of 30 or higher, or a BMI of 27 or greater if the person has weight-related health conditions such as diabetes or high blood pressure. Prescription weight loss drugs are a popular and effective treatment for obesity and health problems related to being overweight. Weight-loss medications may have harmful interactions with other medications, and doctors do not recommend them for people with a history of pancreatitis, medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2. Common side effects of weight-loss medications include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
| Characteristics | Values |
|---|---|
| Common prescription diet pills | Wegovy, Ozempic, Rybelsus, Contrave, Qsymia, Xenical, Alli, Orlistat, Liraglutide (Saxenda), Tirzepatide (Zepbound), Naltrexone-bupropion, Benzphetamine (Didrex), Diethylpropion (Tenuate), Phentermine (Adipex-P, ProFast), Phendimetrazine |
| Who can prescribe them | Primary care doctor, obesity medicine specialist, endocrinologist, cardiologist |
| Who can take them | Adults with a BMI of 30 or greater, or a BMI of 27 or greater with weight-related health conditions such as diabetes, high blood pressure, or high cholesterol |
| How they work | By reducing appetite and cravings, blocking the absorption of fat, or increasing satiety |
| Side effects | Nausea, vomiting, dizziness, insomnia, dry mouth, diarrhoea, constipation, headache, fatigue, allergic reactions, pancreatitis, acute kidney injury, suicidal thoughts |
| Cost | Varies; Xenical costs around $800 for a 1-month supply, while over-the-counter Alli costs less than $60 for a month |
| Effectiveness | Varies; some people may lose 5-21% of their body weight, while others may lose more or less |
| Timeline | The amount of time needed to see results varies from person to person |
| Precautions | Should not be taken by pregnant or breastfeeding women, or those with certain medical conditions such as pancreatitis or thyroid cancer |
| Interactions | May interfere with hormonal birth control or have harmful interactions with other medications |
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What You'll Learn
Who can prescribe diet pills?
Diet pills are typically prescribed to patients with a body mass index (BMI) of 27 or higher, who also have weight-related health problems such as diabetes or high blood pressure. A patient's BMI, current health issues, other medications, family medical history, and the medication's cost and side effects are all factors that doctors consider before prescribing diet pills.
When it comes to prescribing anti-obesity medications, a provider who specialises in obesity medicine is ideal. This could be a doctor certified in obesity medicine, as they have undergone specific training and are equipped to monitor long-term changes like muscle loss, depression, or blood pressure decreases. They can also help patients adjust their diets, exercise routines, and other medications.
While any internal medicine provider with whom a patient can establish a trusted relationship could be a good option for weight management, it is important to ensure that the provider offers multidisciplinary care that focuses on safe prescribing. Close and consistent communication between patients and providers is crucial, and this can be done through in-person visits or telehealth services.
In addition to doctors, some physician assistants and nurse practitioners are also receiving advanced training in obesity care. Therefore, they may also be equipped to prescribe diet pills and manage weight-related health concerns.
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What are the side effects?
When considering taking prescription diet pills, it is important to be aware of the potential side effects. While prescription appetite suppressants can aid in weight loss, they can also have negative impacts on your health.
Short-term prescription appetite suppressants, such as benzphetamine, diethylpropion, phendimetrazine, and phentermine, are controlled substances and carry a risk of addiction. They may cause rapid or irregular heartbeat, mood changes such as depression or anxiety, cognitive changes like agitation or delirium, nausea, vomiting, diarrhoea, constipation, abdominal pain, and other severe side effects. These pills should be used with caution and under medical supervision.
Other weight loss medications, such as semaglutide, liraglutide, orlistat, and tirzepatide, may cause gastrointestinal problems like constipation, upset stomach, bloating, and diarrhoea. More severe potential side effects include stomach, kidney, gallbladder problems, pancreatitis, or hypoglycaemia. Tirzepatide, in particular, may increase the risk of thyroid tumours or thyroid cancer, so patients should be monitored for symptoms like swelling in the neck, hoarseness, trouble swallowing, or shortness of breath.
Additionally, medications like Wegovy and Ozempic, which are approved for people with obesity or related health issues, can cause unpleasant gastrointestinal side effects. A small percentage of people taking these drugs may also experience retinopathy, a diabetes-related eye complication. It is important to note that if you lose weight using these medications, you may need to continue taking them indefinitely to maintain weight loss.
Orlistat is another prescription weight loss medication. While taking orlistat, it is recommended to follow a diet low in fat (less than 30% of total daily calories from fat) to minimise side effects. Side effects may include gastrointestinal issues, and it is advised to take a daily multivitamin containing vitamins A, D, E, K, and beta-carotene.
It is crucial to consult with a healthcare professional before taking any prescription diet pills, as they can help you understand the potential side effects and decide if this treatment is right for you.
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What are the costs?
The costs of prescription diet pills can vary depending on the medication, dosage, and pharmacy. Here are the cost details for some commonly prescribed diet pills:
Qsymia
Qsymia (phentermine/topiramate) is a once-daily prescription diet pill that is often considered one of the most effective options. The retail price of Qsymia ranges from $210 to $280 for a 1-month supply, depending on the dosage and the pharmacy. The manufacturer, Vivus, offers a program to assist with out-of-pocket costs, and coupons are also available to help offset the cost. Qsymia is typically not covered by insurance, but it may be covered by Medicare in certain cases.
Wegovy
Wegovy, a brand name for semaglutide, is available as cartons of four pre-filled pens, with each pen lasting a week. There is currently no generic alternative, and the cost is not explicitly stated. However, it is mentioned that coupons and insurance may help offset the cost.
Contrave
Contrave, a combination of naltrexone and bupropion, is another prescription diet pill. The cost is not specified, but it is mentioned that it is only available as a brand-name medication, and a generic version is not yet available.
Orlistat
Orlistat is available as a prescription medication called Xenical, which costs around $800 for a 1-month supply. However, there are generic versions of orlistat available at a cheaper price. Over-the-counter Alli, which contains half the dose of Xenical, costs less than $60 for a month's supply.
It is important to note that the cost of prescription diet pills is just one factor to consider when making a decision. It is always recommended to consult with a healthcare professional to determine the most suitable option based on effectiveness, safety, and individual needs.
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What are the alternatives?
Weight loss pills are just one of many tools available for losing weight. Here are some alternatives to weight loss pills that can be considered:
Healthy eating plan and physical activity
A healthy eating plan and regular physical activity can help one lose weight and maintain the weight loss in the long term. This includes increasing protein intake, reducing refined carbohydrate intake, and avoiding unnecessary liquid calories. Apps can be used to log meals, track exercise, and receive support from weight-loss coaches.
Appetite suppressants
Appetite suppressants are a type of weight-loss medication that affects how the body and brain experience appetite and hunger. They can be prescribed or over-the-counter. Prescription appetite suppressants can help with weight loss for people with obesity by making them feel less hungry or full faster. However, they are most effective when combined with a reduced-calorie eating plan and regular physical activity.
Injectable weight-loss medications
Injectable weight-loss medications, such as Wegovy (semaglutide), are another alternative to weight-loss pills. Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It is administered as an injection and is intended to be used indefinitely in combination with a healthy diet and exercise.
Orlistat
Orlistat is a lipase inhibitor that comes in a capsule. It works by blocking the enzyme that breaks down fats consumed through food, thus inhibiting the absorption of dietary fats. It is intended to be used with a reduced-calorie diet and can help reduce the risk of weight regain.
Surgery
In some cases, surgery may be an alternative to weight-loss pills. However, it is important to consult with a healthcare professional to determine the most appropriate treatment plan, which may include a combination of medications, diet, exercise, and/or surgery.
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What are the considerations?
When considering prescription weight-loss medication, it is important to remember that they are intended to be used in conjunction with a healthy diet and exercise. Weight-loss medications are typically prescribed to adults with a body mass index (BMI) of 30 or more, or a BMI of 27 or more if the person has weight-related health conditions.
Before prescribing weight-loss medication, doctors will take into account a patient's current health issues, other medications, family medical history, and cost. Doctors will also consider the amount of weight reduction and duration, which will vary by patient. On average, weight loss varies from 5% to 21%, but some people may not lose weight with medication. If weight loss of at least 5% is not achieved within 12-16 weeks, an alternative medication should be considered.
Weight-loss medications may have harmful interactions with other medications, so it is important to discuss any prescribed, over-the-counter, or herbal products with your doctor. Weight-loss medications are not recommended for women who are pregnant, trying to conceive, or breastfeeding, as they may harm the fetus. It is also important to note that weight-loss medications can cause side effects such as nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhoea.
It is important to remember that weight-loss medications are not suitable for everyone, and lifestyle changes such as a healthy diet and regular exercise may be recommended first. If these lifestyle changes are not effective, then medication may be prescribed as part of a weight-control program.
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Frequently asked questions
Doctors consider a patient's current health issues, other medications, family medical history, and cost when prescribing weight loss medication. The patient's BMI is also a critical factor. Most medications are prescribed for patients with a BMI of 30 or greater, or a BMI of 27 or greater if the person has weight-related health conditions.
Prescription weight loss medications include Wegovy, Zepbound, Saxenda, Contrave, Qsymia, and Xenical.
The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. Rare side effects include allergic reactions, pancreatitis, and acute kidney injury.
