4 Types of Weight Loss Medications: Which One Is Right for You?

Obesity is a chronic condition affecting millions, but FDA-approved weight loss medications can help. These treatments, when combined with diet and exercise, can lead to 3%-12% weight loss and improve health markers like blood sugar and blood pressure. Here’s a quick overview of the four main types:

GLP-1 Medications: Regulate appetite and blood sugar (e.g., Wegovy, Ozempic).
- Average Loss: 15%-21%.
- Common Side Effects: Nausea, vomiting, diarrhea.
Fat Absorption Blockers: Prevent fat absorption (e.g., Orlistat).
- Average Loss: 3%-4%.
- Common Side Effects: Oily stools, stomach discomfort.
Appetite Control Medications: Reduce hunger (e.g., Phentermine).
- Average Loss: 6%-11%.
- Common Side Effects: Insomnia, dry mouth, increased heart rate.
Mood/Craving Control Drugs: Address emotional eating (e.g., Contrave).
- Average Loss: 5%-9%.
- Common Side Effects: Nausea, headache, constipation.

Quick Comparison:

Medication Type	Average Weight Loss	Key Benefits	Common Side Effects	Best Suited For
GLP-1 Agonists	15%-21%	Appetite control, blood sugar benefits	Nausea, diarrhea, vomiting	Obesity with/without weight-related conditions
Fat Absorption Blockers	3%-4%	Long-term safety, OTC availability	Oily stools, stomach issues	Low-fat diet users seeking modest weight loss
Appetite Suppressants	6%-11%	Effective hunger reduction	Insomnia, dry mouth, high blood pressure	Adults aiming for significant weight loss
Mood/Craving Control	5%-9%	Helps with emotional eating	Nausea, headache, constipation	Emotional eaters with cravings

Consult your doctor to find the best option based on your health, goals, and lifestyle. Pair medication with healthy habits for lasting results.

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GLP-1 Medications

GLP-1 medications work by mimicking a natural hormone to help with weight loss. Clinical studies have shown they can lead to noticeable reductions in body weight.

How GLP-1s Work

These medications imitate the glucagon-like peptide-1 hormone, which is released by the intestines after eating. This triggers several effects that aid in weight loss:

Slows down how quickly the stomach empties
Increases insulin release
Reduces appetite
Improves feelings of fullness

By addressing hunger and overeating, these medications help support long-term weight management.

Common GLP-1 Options

There are several FDA-approved GLP-1 medications, each with specific dosing recommendations and results:

Medication	Weekly Dose	Average Weight Loss
Zepbound (tirzepatide)	2.5–15 mg	Up to 21% over 72 weeks
Wegovy (semaglutide)	1.7–2.4 mg	About 15% over 68 weeks
Ozempic (semaglutide)	0.5–2 mg	Around 5.9% at 3 months

For example, clinical data shows that 86.4% of patients using semaglutide lost at least 5% of their body weight by week 68, compared to only 31.5% in the placebo group.

Side Effects and Patient Fit

These medications are generally prescribed for adults with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher if weight-related health issues are present.

Dr. Sue Pedersen, an Endocrinologist and Obesity Medicine Specialist, highlights:

"Semaglutide is the first GLP-1 receptor agonist proven to reduce heart risks in non-diabetic individuals."

However, common side effects include nausea, vomiting, diarrhea, and constipation. Dr. Mir Ali from MemorialCare Surgical Weight Loss Center notes:

"As these medications increase in use and popularity, we will likely see more effects as people achieve their weight loss goals; there are still concerns with weight gain after stopping these medications, so more research is needed in order to understand the main reasons for the weight gain."

These medications aren’t recommended for pregnant or breastfeeding individuals or those with medullary thyroid carcinoma. For the best results, they should be paired with lifestyle changes like a healthy diet and regular exercise. Matching the right medication to a person’s health needs is key.

Next, we’ll look at fat absorption blockers, another approach to weight management.

Fat Absorption Blockers

Fat absorption blockers help reduce the amount of dietary fat your body digests. These medications work in your digestive system, targeting fat breakdown rather than appetite or metabolism.

How Fat Blockers Work

Orlistat, a common fat blocker, inhibits lipases - enzymes responsible for breaking down dietary fat. By doing so, it prevents around 30% of consumed fat from being absorbed, and the unabsorbed fat is eliminated through bowel movements. Research suggests the best results occur when dietary fat makes up 40% of daily calories, though experts recommend limiting fat intake to 30% to reduce side effects. Over time, this process can lead to noticeable weight loss.

Results and Side Effects

The XENDOS study found that participants taking orlistat lost an average of 13 pounds over four years, compared to 7 pounds in the placebo group. Additionally, orlistat use was linked to a reduced risk of developing type 2 diabetes.

However, side effects are fairly common and include:

Oily discharge (which may stain clothing)
More frequent and loose bowel movements
Urgent need for bowel movements
Stomach discomfort

These factors help determine who might benefit most from fat blockers.

Best Candidates

Fat blockers are typically recommended for specific groups:

Overweight individuals with conditions like high blood pressure, diabetes, high cholesterol, or heart disease
Those aiming to maintain weight loss or prevent regaining weight

Candidates should follow a low-fat diet, evenly spread calorie intake across meals, and take a multivitamin at least two hours apart from orlistat to address reduced absorption of fat-soluble vitamins.

Regular check-ins with a healthcare provider are crucial, as some users have reported serious side effects, including liver damage.

Appetite Control Medications

Unlike GLP-1 therapies, appetite control medications work by influencing the brain and hormones that regulate hunger and cravings, helping people manage their weight more effectively.

How They Work

These medications adjust neural pathways to reduce hunger and increase feelings of fullness. For instance:

Phentermine, a stimulant-based suppressant, lowers appetite while boosting calorie burn.
Contrave, a combination drug, targets the brain's reward system to minimize cravings.

Some common actions include:

Slowing stomach emptying
Triggering fullness signals
Reducing calorie consumption

These effects often lead to noticeable weight loss.

Weight Loss Outcomes

When paired with lifestyle changes, prescription appetite suppressants can help achieve 3%–12% more weight loss than lifestyle changes alone. Clinical data suggest:

An average loss of at least 5% of starting body weight
Between 6% and 11% with newer combination drugs

However, results depend on individual factors, which should be evaluated before starting treatment.

Who Can Benefit

Ideal Candidates

These medications are most effective for individuals who meet the following criteria:

A BMI over 30, or over 27 with weight-related health issues
Previous struggles with weight loss despite diet and exercise efforts
Commitment to regular medical follow-ups

Who Should Avoid Them

These medications are not recommended for:

Pregnant women or those planning to become pregnant
People with uncontrolled high blood pressure
Individuals at high risk for cardiovascular problems

For the best results, these medications should be combined with a low-calorie diet and consistent exercise. Ongoing medical supervision ensures safety, allows for adjustments, and helps manage any side effects.

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Mood and Craving Control Drugs

Mood and craving control drugs take a different approach than earlier medications by addressing the emotional side of eating. They target both emotional and physical hunger, focusing on how emotions impact eating habits.

Weight Loss Methods

Medications like naltrexone and bupropion (sold as Contrave) work by reducing the brain's response to food-related pleasure. Here's how they help:

Adjust the brain's reward system to make eating less rewarding.
Help curb stress-induced eating by affecting neurotransmitters.
Boost feelings of fullness by increasing POMC peptide production.

"It's not just about our willpower... This is a disease that requires treatment, and there's treatment that can now help us. And I think for a lot of people, that is really liberating." – Sara

Results and Risks

The results so far are encouraging. For instance, at Dr. Marlowe's Weight Loss Institute, 19 out of 20 patients using bupropion-based treatments reported better energy levels, improved personal relationships, and enhanced work performance.

But, like any medication, there are potential side effects. Up to 30% of users experience nausea. Other common issues include dry mouth, insomnia, and constipation. Rare but more serious risks include anxiety, high blood pressure, mania, and seizures.

"The idea behind Contrave is that it really helps with emotional eating by interfering with the brain's reward center - sort of the way it works for addiction. You don't get that feeling of goodness from eating any more." – Sarah Fishman, M.D.

Because of these risks, healthcare providers carefully assess patients to ensure the medication is a good fit.

Patient Match

These drugs are most effective for people dealing with stress-related eating, strong food cravings, and challenges managing both weight and mood. However, they aren't suitable for everyone. People with a history of anorexia, seizure disorders, or those taking MAO inhibitors should avoid them.

Starting treatment during a calmer period in life, when stress is lower, often leads to better results. Regular check-ins with your doctor are essential to ensure the medication is working safely and effectively.

"If possible, it's best to start a new medication when you have some down time or days off, rather than needing to be in the thick of it or under pressure to perform or meet deadlines." – David Merrill, MD, PhD

Medication Comparison

Compare weight loss medications based on effectiveness, side effects, and suitability. Use the quick reference guide below for a side-by-side overview.

Quick Reference Guide

Medication Type	Average Weight Loss	Key Benefits	Common Side Effects	Best Suited For
GLP-1 Agonists (Semaglutide, Liraglutide)	14.9% over 68 weeks	• High weight loss potential • Improves blood sugar levels • Weekly dosing options	• Nausea (44%) • Diarrhea (30%) • Vomiting (24%)	Adults with a BMI ≥30 or ≥27 with weight-related conditions
Fat Absorption Blockers (Orlistat)	3.4% over 52 weeks	• Long safety record • Over-the-counter availability • Approved for ages 12+	• Oily discharge • Increased bowel movements • Diarrhea (30%)	Individuals on a low-fat diet needing modest weight loss
Appetite Control (Phentermine/Topiramate)	10.9% over 52 weeks	• Reduces appetite effectively • Lower discontinuation rate • Affordable option	• High blood pressure (20%) • Insomnia • Dry mouth	Adults aiming for significant weight loss with proper monitoring
Mood/Craving Control (Naltrexone/Bupropion)	5.0–9.3% over 56 weeks	• Helps manage emotional eating • Reduces food cravings • Boosts energy levels	• Nausea • Constipation • Headache	Those dealing with emotional eating and cravings

"If these medications are used with a behavioral lifestyle program to change eating behaviors, that's where the real magic comes in. That, in my mind, signals long-term, successful weight management."
– Dr. Peter Vash, M.D., Endocrinologist and Obesity Medicine Specialist

Direct comparisons show that semaglutide leads to 15.8% weight loss, compared to 6.4% for liraglutide and 1.9% for placebo.

When choosing a medication, consider:

Medical History: Pre-existing conditions and current medications
Weight Loss Goals: Whether modest or more substantial results are needed
Side Effect Tolerance: Your ability to handle potential side effects
Cost and Coverage: Insurance plans and out-of-pocket costs
Lifestyle Factors: Eating habits and daily routines

Studies indicate that maintaining a 5% weight loss can significantly reduce health risks. Reassess your progress after 12 weeks. If weight loss is less than 5%, discuss alternative options with your provider to minimize unnecessary risks. Tailor the choice to your health needs, goals, and lifestyle.

Selecting Your Medication

Choosing the right weight loss medication involves reviewing your health profile and discussing options with your healthcare provider.

Medical Considerations

Consider your current medications, pre-existing conditions, family health history, allergies, and whether you're pregnant or planning a family. These factors play a key role in determining which medication is safe and suitable for you.

Lifestyle habits also influence how well a medication works.

"Weight management medications are intended for individuals with health problems related to overweight or obesity. Ask your health care professional if you have medical conditions that could increase your risk of developing health problems when taking weight-loss medications." – FDA Guidelines

Diet and Exercise

Studies show that prescription weight-loss medications can lead to a 5% to 10% reduction in body weight. Pairing these medications with proper nutrition and exercise improves their effectiveness.

Suggested Activity Levels:

150 minutes of moderate-intensity exercise weekly
Two resistance training sessions per week
Focus on building and maintaining muscle quality

When combined with the right medication and regular check-ins, these habits can lead to better long-term results.

"These medications have changed how we need to think about activity. They can take care of the weight loss for us, so our focus should not be on how much activity we need to do to lose more weight; it should be about all the other things the activity does that the weight loss medications don't do." – John Jakicic, Ph.D., University of Kansas Medical Center

Progress Tracking

Tracking your progress is just as important as selecting the right medication and adopting healthy habits.

What to Monitor Weekly:

Weight: Measure at the same time on the same day each week.
Side Effects: Note any symptoms and their severity daily.
Appetite & Energy: Observe changes in hunger levels and energy.
Blood Sugar (if applicable): Keep an eye on levels as advised by your provider.

If you don’t see at least a 5% weight loss after 12 weeks on the full dose, consult your healthcare provider.

Progress Metric	Tracking Frequency	Action Items
Body Weight	Weekly	Record at the same time/day
Side Effects	Daily	Document type and severity
Blood Work	As prescribed	Monitor relevant markers
Medication Response	Monthly	Evaluate how well it's working

Summary

Weight loss medications work by targeting different aspects of weight regulation, such as appetite control, fat absorption, and emotional eating triggers. These medications fall into several categories: GLP-1 medications help regulate hormones and blood sugar, fat absorption blockers prevent the body from absorbing dietary fat, appetite suppressants help reduce hunger, and mood-related medications address emotional eating. Newer treatments like tirzepatide have shown better outcomes compared to older options.

"Newer approaches treat obesity as an endocrine disease, offering tailored medication options." - Robert Kushner, MD, Professor at the Northwestern University Feinberg School of Medicine

To choose the right medication, it's important to work with an obesity medicine clinician who can create a plan tailored to your needs. Tools like the Obesity Medicine Association's provider database can help you find a specialist. When combined with proper nutrition and exercise, these medications can lead to an additional 3-12% weight loss.