Appropriate pharmacotherapy can augment diet, physical activity, and behavior therapy as treatment for patients with a BMI of 30 or higher, or patients with BMI of 27 or higher who also have significant risk factors or disease. These agents can decrease appetite, reduce absorption of fat, or increase energy expenditure.
Medications can be categorized as central nervous system acting agents and not central nervous system acting agents. The central nervous system acting agents are catecholaminergic agents, serotoninergic agents, and a combination of these. Side effects of central nervous system acting agents are dry mouth, headache, insomnia, and constipation.
Meridia (sibutramine) is a medication for long-term use in the treatment of obesity. It increase satiety, reduces hunger, and lessens the drop in metabolic rate that often occurs with weight loss. Some studies demonstrate the efficacy of Meridia as a weight loss and weight maintenance agent for obesity in Type II diabetes. It is not appropriate for patients with a history of CAD and related disorders, because of cardiovascular side effects. Sibutramine should not be used in combination with certain antidepressant agents such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors or other central acting agents such as pseudoephedrine or ephedra. The interaction may cause elevated blood pressure.
There are much more medicaments used for short term weight loss. Preludin and Biphetamine as amphetamines have a high potential for abuse and are not recommended for obesity treatment. Didrex, Bontril, Slow release Bontril, Prelu-2, Plegine, X-Trozine, Extended release X-Trozine – all these agents also pose abuse and should be carefully considered. Commonly used agents such as Adipex-P, Fastin, Obenix, Oby-Cap, Oby-Trim, Zantryl, Ionamin have a low potential for abuse. But they have effect on blood pressure, so they are prescribed with caution in patients even with mild hypertension.
Not central nervous system acting agent – Orlistat – does not suppress the appetite. Orlistat inhibits GI lipase, which reduces approximately one third the amount of fat that is absorbed from food. Depending on the fat content of a person’s diet, this lowered absorption can represent up to 200 kcal/day. The reduction in lipid absorption with orlistat causes concern for the absorption of fat-soluble vitamins. Supplements of these vitamins are recommended, with care to separate the dosing of orlistat and the supplement by 2 hours and more. Orlistat side effects: oily spotting, fecal urgency and flatus with discharge. Health benefits are reduced LDL cholesterol and elevated HDL cholesterol, improved glycemic control, and reduced blood pressure.
Natural weight loss aids
Chitosan – these indigestible compounds are over-the-counter weight loss agents. Claims are that chitosan blocks fat absorption. There are no positive effects.
Chromium – potentiates the action of insulin in carbohydrate, lipid and protein metabolism.
DHEA – cause liver cancer in rats. Supplementation can lead to increased insulin resistance, the growth of unwanted hair, and a drop in high-density lipoprotein cholesterol, increasing the risk for heart disease.
Ma huang (ephedra)- promoters claimed benefits such as weight loss, increased energy, performance enhancement, and increased LBM. It is a central nervous system stimulant. It increases blood pressure and heart rate and is hazardous to those with heart ailments, diabetes, hypertension, and thyroid conditions. When combined with caffeine-containing herbs (kola nut, guarana, mat), ephedra can be especially hazardous. Now it is removed from the market of side effects (heart attacks, hepatitis, several deaths).
Senna – a potent cathartic. Side effect is diarrhea, it can lead to low potassium levels.
As you see, medicaments are not magic pills to cure obesity. Medication without lifestyle modification is less effective. Lots of people think, that diets don’t work. The lure of a quick and easy solution to the challenge of weight management is strong, and the market for natural weight loss aids is booming. Many patients want fats results. Currently none of the 50 individual weight loss supplements meet criteria for effective or recommended use.