Are Older Weight Loss Medications Still Useful?

These days, there’s a lot of buzz around the new injectable weight loss medications. Wegovy® and Zepbound™ are making headlines because they help people lose a lot of weight—15% and 20% of body weight, respectively—and they even help with health problems like heart disease and sleep apnea.

But what about the older medications? Do they still have a place in weight loss treatment?

The answer is yes.

Let’s take a closer look.

The Classic Options

Phentermine and Tenuate are two of the oldest weight loss medications still used today. They’ve been around since 1959 and can help people lose about 10% of their body weight or more. These medications often help with energy, focus, and sometimes even mood.

They’re not right for everyone—people with heart disease or uncontrolled high blood pressure shouldn’t use them—but for many, they work well and are easy to tolerate. Another big plus? They’re much more affordable, usually costing between $25 and $50 per month. That’s a big difference compared to the newer options, which can cost around $499 per month without insurance.

Other Oral Medications

There are also two newer oral medications approved for long-term use: Contrave® and Qsymia®.

• Contrave helps with emotional eating and food cravings.
• Qsymia is a combination of phentermine and another medication called topiramate. This combo can lead to a bit more weight loss than phentermine alone, and it only needs to be taken once a day.

These medications usually cost between $98 and $135 per month and can also help people lose 10% or more of their weight when combined with a healthy eating and activity plan.

Which One Is Right for You?

Not everyone needs to start with the new injectables. Here’s a simple guide to help you think about where to begin:

1. If your BMI is in the lower range (27–30) and you don’t have many weight-related health issues, starting with phentermine or tenuate might be a great option. We can always adjust later if needed.
2. If you need more weight loss than phentermine gives, consider Qsymia or adding topiramate to phentermine. If phentermine doesn’t work well for you, Contrave might help more with cravings and emotional eating.
3. If you have heart disease or peripheral artery disease, it’s safer to start with Wegovy.
4. If you have sleep apnea, Zepbound might be the best fit.
5. If you need the extra weight loss that a GLP-1 (like Wegovy or Zepbound) offers, you might begin with an oral medication and switch later if needed.

The Bottom Line

There’s no one-size-fits-all approach to weight loss. Everyone is different. That’s why at Clinical Nutrition Center, we take the time to get to know you and your health goals before choosing a medication. Whether it’s an older, affordable option or one of the newer injectables, we’ll help you find what works best for you.