Should I be on a Weight Loss Medication?

If your BMI is over 30, or over 27 with weight-related health problems like pre-diabetes, hypertension or high cholesterol, then anti-obesity pharmacotherapy is indicated. Another way of thinking about this – if your BMI poses a risk to your health, and the benefits of anti-obesity pharmacotherapy outweigh the risks, then yes, the use of weight loss medications in addition to healthy eating, physical activity and lifestyle interventions is recommended.

What if I don’t take medication?

If we do not treat obesity, it tends to get worse over time, much like diabetes. Most Americans are gaining 1-2 pounds per year, so if your BMI is 30 now, it is likely to get higher over time and pose a more significant risk to your health.

How long do I need to take medication?

Like diabetes, we treat obesity chronically. Medications do not work if they are not in your body. The practice of using medications short-term was popular in the 1990s, but is no longer considered appropriate.

Pills vs. shots

Believe it or not, FDA-approved weight loss medications have been available since 1959, when the FDA first established a pathway for these drugs and approved Phentermine and Tenuate. Today, there has been an explosion in popularity due to media attention. A lot of this attention is being focused on the newest GLP-1 injectable weight loss medications, including Wegovy (semaglutide) and Zepbound (tirzepatide).

Comparison of Oral and Injectable Anti-Obesity (Weight Loss) Medications

	Oral (pills / capsules)	Injectable (self-administered shots)
Medication Names	Phentermine, Tenuate (generic) Contrave, Qsymia (brand)	Wegovy (semaglutide / Ozempic) – weekly Zepbound (tirzepatide / Mounjaro) – weekly Saxenda (liraglutide / Victoza) – daily
Cost	$25-$50 / month (generic) ~$100-$150 / month (brand)	$25-$50 / month (Insurance) $450-$1500 / month (Cash)
Weight Loss (% of total body weight lost at 1 year)	~10% 20-25 Pounds	~15-20% 35-50 Pounds
Availability	Available at CNC and at retail pharmacies No shortages of any medication at any dose	Shortages abound on all doses. Many patients are having to stop treatment due to supply issues (April, 2024)
Side Effects	Mild stimulant side effects, similar to a cup of coffee. Can cause anxiety, headaches, insomnia. Can elevate blood pressure.	Nausea, Vomiting, Diarrhea, Constipation, Heartburn, Burping, Fatigue, Headaches, Gallbladder attacks, pancreatitis, gastroparesis (?),
Other Health Benefits	Can improve energy and focus. Sometimes improves mood.	Prevent recurrent major adverse cardiovascular events. Also, may improve heart failure, fatty liver disease, chronic kidney disease, reduce diabetes risk and improve diabetes control.
Other Considerations	Genuine generics or generic equivalents available for all existing oral medications.	No generics currently exist. Fakes, Counterfeits, and Compounds are rampant. The source ingredient in compounds is NOT regulated by the FDA, and is likely being imported from other countries including China and India. *FDA-Approved Authentic generic liraglutide (Saxenda / Victoza) is expected in late 2024.

How to choose a weight loss medication?

1. The most important decision is whether or not to start an anti-obesity medication. Again, if your body fat poses a risk to your health, and the benefit of medical treatment outweighs the risk, then we recommend starting on an anti-obesity medication.
2. If you have existing heart disease, insurance coverage, and the medication is available, then we recommend a medication that reduces recurrent heart attack risk – at the time of this article (4/24), the only medication approved for this indication is Wegovy.
3. If you do not have a contraindication like uncontrolled high blood pressure, we generally recommend starting on an older oral medication first. For many patients this is adequate. If it causes side effects or does not provide an adequate result, we can always add or move to injectable at a later date.
4. If you do not lose adequate weight on an oral medication, then we may recommend changing to one of the newer injections like Wegovy or Zepbound, provided you have insurance coverage (or are otherwise able to afford it) and that the medication is available.
5. For more information on Wegovy (semaglutide) vs. Zepbound (tirzepatide), click here.