The pharmacological treatment of obesity is gaining popularity. The FDA authorized only a few weight loss drugs before the year 2012. The popular medications at that time were phentermine sold under the brand name Lomaira and Adipex-P, orlistat sold under the brand name Xenical and Alli, and phentermine-topiramate, a combination of topiramate that is also used to manage binge-eating disorder.

Brand-name GLP-1 receptor agonists including Wegovy and Ozempic created overwhelming media hype when they entered the market. According to research published in the journal Frontiers in Cardiovascular Medicine 2022, such medications have increasingly been sought and prescribed by the general population.

Now that there are more medications for weight loss available in the market, a patient may wonder what is the most potent weight-loss medication that has ever been developed. This has a more complicated answer. For any patient two factors are substantial in selecting the right drug for them. The market as always is very dynamic, so it is necessary to adjust to the current trends and their advantages and disadvantages.

Characteristics of Weight Loss Medication Advertised Prescriptions

​BMI seems to be the first screening to determine whether someone requires such weight loss medications. As a rule of thumb, weight loss medications are for people with a BMI greater than thirty, or an individual with a BMI of twenty seven and has conditions where weight is a contributory factor.

By November 2023, the use of Zepbound schould be available for adults with BMI of 30 or higher. Some other conditions that the doctor and the patient would consider should include what other health issues the patient currently may have and medications and illnesses in the family. This decision will also be influenced by the cost of the drug and its anticipated side effects.

Some weight loss drugs are approved by the FDA for use in adults aged 18 years and older, while semaglutide, liraglutide and orlistat have been approved for children aged 12 years onwards. The entire mentioned medications, in our case, are contraindicated to be married during pregnancy.

Weight Loss Medications: The New Hope

Throughout the ages, a variety of weight loss medications have happily flooded the market, some quite recently, and clinical trials for even newer ones are being carried out. These new medications which are emerging can be prescribed for patients of all ages. These include:

Semaglutide (Wegovy, Ozempic)

Wegovy is the brand name of semaglutide, a GLP-1 receptor agonist. The drug was approved by the FDA in 2021. The drug is inject able and is approved for those aged 12 years and above who are diagnosed with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile in the age and sex) or for some non-obese adults (BMI ≥ 27) who are overweight and suffering from weight-related problems. To reach the dosage of 2.4 mg, the dose has to be progressively raised over 16 to 20 weeks. Making the gradual increase can help reduce these side effects, including gastrointestinal symptoms, headache, dizziness, and fatigue in many patients.

The same medicine, Ozempic, is used only to take care of type 2 diabetes.

Zepbound, Mounjaro: Tirzepatide

Tirzepatide was previously approved to be used in Mounjaro, which was prescribed for patients diagnosed with type 2 diabetes. In its newer form as Zepbound, it is also permitted for adults who have been diagnosed with obesity and carry a BMI above 30.

Both a GLP-1 and GIP receptor agonist imply that it acts similarly to semaglutide by reducing appetite, and obesity measures such as diet and exercise must be combined for the weight effect to occur. This is also always given by injection. A drug that helps patients and scientists alike will be Liraglutide (Saxenda).

Patients will never stop wishing they had saxenda is Liraglutide every day injectable medication that target hormones produced in the gut that will send signals to the brain quicker, allowing the patient to fill up much faster and reduce hormone responsible for hunger. The normal treatment tends to start from 0.6 mg and increase to around 3 mg a day usually. 5-10% in certain patients can be achieved but would imagine most people however optimal results might be seen with higher doses of Lira.

Other complications might include but are not limited to Nausea, Diarrhea, Constipation, vomiting, headache, loss of appetite, dyspepsia, fatigue, lightheadedness, and pain in the abdomen region bringing greater meaning to the phrase ‘pain in the neck’. Two people with a personal or family history of medullary thyroid carcinoma or MeN2-type Multiple endocrine neoplasia syndromes are risk-free. As the oldest drug approved for weight loss it remains in the highest active pharmaceutical ingredient, known as phentermine.

Originally thought to use phentermine was only applicable for short-term because people needed inspiration to start losing weight. However, newer medical advancements have recommended much longer recovery periods for those using the pill. It seems likely that if some people took phentermine regularly as advised through medical professionals their weight could wing about 5%.

Phentermine is generally sold in its HCl formulation in the United States at two strengths of 15 mg and 30 mg. The most common side effects however include: headache, excess stimulation, elevated blood pressure, insomnia, tachycardia or arrhythmia and shaking.

Interactions can happen during therapy and even within 14 days after the use of monoamine oxidase inhibitors (MAO), sympathomimetics, alcohol, adrenergic neuron blocking agents as well as some anesthetic agents.

Phentermine-topiramate (syn Qsymia)

Phentermine may be combined with topiramate in order to control appetite and reduce consumption desires. The use of the two drugs provides an additive effect.

This antiobesity medication is suitable for obese patients with migraines. Some subjects may lose almost about 5–10% of the total body weight on average.

However, if there is no evidential negative result of more than 5% weight reduction after 12 weeks of maximum dose, the use of the phentermine pills should be tapered off.

The initial daily dose of the four strengths begins with 3.75 mg/23 mg up to 15 mg/92 mg. Adverse drug reactions: abnormal feeling, dizziness, taste alteration, insomnia, constipation and dry mouth. Contraindications: Uncontrolled high blood pressure and coronary artery disease, hyperactive thyroid gland, glaucoma and sensitivity to stimulants.

Naltrexone-bupropion (Contrave)

Naltrexone-bupropion utilizes the antagonist component of opium receptors with an anti-depressant in order to diminish cravings and appetite, concentrating also in the pleasure-reward centers of the brain. Some patients may achieve a 5-10% change in body weight.

One starts with a single 8/90 mg tablet once a day, gradually raising the total number of tablets taken in one day to four. The most common unfavorable effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. This medication should never be recommended to a patient with a seizure condition or a chronic pain patient on opioid medication.

Setmelanotide (Imcivree)

Setmelanotide is a melanocortin-4 receptor agonist that is approved for the long-term treatment of obesity in adult and pediatric patients aged 6 and older with specific, rare genetic disorders.

This must be established by genetic testing that confirms the presence of pathogenic or likely pathogenic mutations, or VUS in POMC, PCSK1, and LEPR.

Orlistat (Xenical and Alli)

Orlistat is administered in capsule form and as a lipase inhibitor works by blocking the enzyme that breaks down fats ingested from food. This way, it prevents the dietary fat from being absorbed.

In case of obstruction, undigested fat shall be taken out of the body. To minimize weight regain, this medication should be taken with a low-calorie diet.

Some patients may lose maybe 5 percent. The dosage is three times 120 mg capsule which should be taken with each main meal comprising of fat.

Each meal comprises of 60 mg capsule of an over the counter formulation. The most common adverse effects of orlistat are oily rectal discharge, flatus with discharge, increased defecation and fecal incontinence.

Hydrogel, Plenity.

Hydrogel, Plenity, is a medical device rather than a drug that was approved in the United States in 2019 for people with a body mass index ranging between 24 and forty. This treatment has gained much attention after GLP-1 receptor agonists became popular.

The capsule contains a super-absorbent hydrogel matrix which disperses within the stomach. A person consumes less intake than is required. Average weight loss in real world studies is 9%.

For a description of each of the above described weight loss medicines please refer to the latest edition of Obesity Medicine Association’s Obesity Algorithm®.

Pharmaceuticals for Weight Loss in the Future

In the years to come, more medications are bound to be introduced to the market owing to the increasing rate of obesity and the strong demand for weight loss medications from the consumers.

Orforglipron, an oral glucagon-like peptide one receptor blocker, is being developed by Lilly. The other one includes Retatrutide which is injectable and targets GLP-1 in addition to GIP and glucagon. Furthermore, two GLP-1 inhibitors administered in oral form are being developed by Pfizer. Similarly, Amgen is also working in trialing a drug candidate with one GLP-1 receptor agonist and one GIP receptor antagonistic activity, unlike semaglutide that is a dual-agonistic.

The researchers are also looking for such hormones which are responsible for appetite and appetite control, such as peptide YY, for other options to address obesity with medicines.

Drugs for obesity treatment have been evolving and, as Robert Kushner, MD noted in July 2021 during an interview by Endocrine News, “The new perspective that doctors should be looking at obesity – more as an endocrine disease pathology than just a weight problem.” He adds, glorifying “the new direction that we are going in obesity treatment, treating it more as an endocrine disease, treating it hormonally…” – to provide patients and providers a variety of drugs.