Physician-supervised Options

Physician-supervised weight-loss programs are one-on-one treatment options that take place in a medical office. These programs are led by a healthcare provider (HCP) such as a:

• Medical provider (MD, DO, PA, NP)
• Registered dietitian (RD)
• Health psychologist

Many times, several HCPs are involved and work as a team in these programs, as they include not only medical advice but also nutrition and lifestyle counseling.

The costs of these programs vary depending on the services offered. Your health insurance company might cover all or some of this treatment. If you have additional obesity-related health conditions such as high blood pressure or type 2 diabetes, they might affect your coverage for these treatment options. Make sure you read and understand your insurance coverage.

For long-term weight management, having a healthcare team that you feel comfortable with and who is trained in obesity medicine is crucial. If you do not currently have a physician that meets your needs, you should explore working with another physician. For help finding physicians and other healthcare providers in your area who are trained in obesity medicine, visit the OAC’s Obesity Care Provider Locator at ObesityCareProviders.com.

Your first consultation with a healthcare provider may include:

• A detailed medical evaluation for obesity-related conditions
• A look into your daily lifestyle
• A physical exam
• A weight history (including past weight-loss attempts)
• A psychological history

Patients may have undiagnosed type 2 diabetes, high cholesterol, thyroid disorders or sleep apnea. Additional tests may be recommended based on your medical history and your initial physical exam. To help manage any obesity-related conditions as well as weight-loss, your program may include:

• Pre-packaged meal replacement plans
• Medical weight management

Pre-Packaged Meal Replacement Plans

Pre-packaged meal replacement plans are a medically supervised weight-loss program. They use meal replacement options along with lifestyle modifications and behavior change counseling to help people reach and maintain their weight-loss and health goals. These programs work as a transition to a healthier, self-prepared nutrition plan while offering education and support. Examples of these programs include:

• • OPTIFAST®
  • Health Management ResourcesTM (HMR)
  • Advanced Health SystemTM (AHS)
  • New DirectionTM (Robard Corporation)
  • Medi-FastTM

How Does it Work? Individuals who are interested in starting a supervised weight-loss program must do so through an HCP. Most programs list participating providers on their websites.

A medically supervised weight-loss program has individualized phases. The phases generally begin with meal replacements and transition to the use of self-prepared foods for long-term weight-loss. These programs also include guidance from a team of HCPs, access to group or individual counseling, and other support options. Each program will vary and it is important to discuss them with your HCP to find the best option for you.

Weight-loss: Individual results will vary, but patients may lose as much as 50 pounds or more over 18 to 24 weeks.

Concerns: As with any meal replacement program, there are concerns about the ability of participants to successfully readjust to eating healthy, self-prepared foods following the meal replacement phase. Additionally, insurance coverage varies, so interested individuals need to review their health insurance policy and contact their health insurance company if they have questions or concerns about their coverage.

Medical Weight Management

Who is a Candidate for Medications That Help Treat Obesity?

Many people have found that lifestyle changes, combined with medications that aid in weight-loss, have been very effective for long-term weight management.

The FDA has approved seven prescription medications for use in people with a BMI more than 30 or a BMI more than 27 when a patient has additional obesity-related conditions. They are available by prescription only, and you will need to discuss them with your HCP.

Chronic Weight Management Medications

• Phentermine Products Adipex® Lomaira® or Suprenza® – Approved for short-term use
• Orlistat, Xenical® or alli® – Approved for long-term use
• Naltrexone HCI and Bupropion HCI CONTRAVE® – Approved for long-term use
• Phentermine – Topiramate ER Qsymia® – Approved for long-term use
• Liraglutide Injection Saxenda® – Approved for long-term use
• Semaglutide Injection Wegovy® – Approved for long-term use
• Tirzepatide Injection Zepbound® – Approved for long-term use
• Setmelanotide Injection IMCIVREE® (for specific rare genetic diseases of obesity in children) – Approved for long-term use

The average weight-loss resulting from prescription weight-loss drugs is 5-21% of your starting weight. It is important to know that everyone responds differently to medications. Most people who take the medication will see average results, while others may see more significant weight-loss or none at all.

Will My Insurance Cover Medications to Treat Obesity?

Insurance coverage of prescription weight-loss medications varies by state and by insurance provider. You can log into your insurance provider’s website and look under the pharmacy benefits page to see if your insurance plan covers the medication you are considering.

A Closer Look at Medical Weight-loss Medications:

Adipex®, Lomaira® and Suprenza® (Phentermine)

How does it work? Phentermine is a prescription-only weight-loss medication that has been FDA-approved since 1959. It works by acting on chemicals in your brain to decrease your appetite and contains a mild stimulant to boost energy levels. Phentermine is taken in pill form once daily in the morning and is intended for short-term use.

Weight-loss: On average, individuals lose about 4-5% of their initial weight after one year. For a person weighing 200 pounds, this is approximately a 10-pound weight-loss.

Concerns: Because Phentermine is a stimulant, it may increase your blood pressure and heart rate. Therefore, it’s essential to be monitored by a healthcare professional experienced in prescribing it. Patients with certain heart conditions (such as uncontrolled high blood pressure), glaucoma, a history of stroke, or an overactive thyroid should avoid this medication.

Xenical® and alli® (Orlistat)

How does it work? Orlistat is available over-the-counter as alli® and is also available in a higher dose prescription called Xenical®. Both are FDA-approved for weight-loss and work by decreasing the amount of fat your body absorbs. It is taken three times daily before meals containing dietary fat. Orlistat only allows your body to absorb two-thirds of the calories from the fat you consume. The other one third is carried away through digestion and becomes part of your stool.

Weight-loss: On average, individuals lose about 5% of their initial body weight. For a person weighing 200 pounds, this is approximately a 10-pound weight-loss.

Concerns: For individuals who are already consuming a low-fat diet, this medication may not be as effective since their calorie intake from fat is already reduced. People taking Orlistat should supplement with a multivitamin, as they are at an increased risk for vitamin deficiencies. Side effects are limited but can include cramps, gas, stool leakage, oil spotting and gas with discharge. These symptoms tend to improve with a lower-fat diet.

Naltrexone HCI/Bupropion HCI (Contrave®)

How does it work? Contrave® was FDA-approved in 2014 and combines two medications, Naltrexone and Buproprion, which were previously approved for other medical conditions. Naltrexone is used to treat narcotic and alcohol dependency, while Buproprion is an anti-depressant that helps with smoking cessation.  When combined, these medications work to reduce appetite and assist in controlling eating habits.

Weight-loss: Among individuals who took Contrave® for one year, 65% lost at least 5% of their initial weight (equivalent to a 10-pound weight-loss for someone weighing 200 pounds) and 39% lost at least 10% of their weight (a 20-pound weight-loss for someone weighing 200 pounds).

Concerns: The most common side effects of Contrave® include nausea, constipation, headache, dry mouth, vomiting and dizziness. Additionally, there is a small occurrence (6%) of increased blood pressure and heart rate.

Phentermine-Topiramate ER (Qsymia®)

How does it work? This combination medication was approved by the FDA in 2012. Qsymia® is a weight-loss drug  initially approved by the FDA in 1959. Traditionally, Qsymia® is used to prevent migraines and seizures. Together, these medications reduce appetite and increase feelings of fullness after eating.

Weight-loss: The extent of weight-loss can vary depending on the dosage. At the lower dose, 62% of individuals on Qsymia® lost 5% of their starting weight, which is approximately a 10-pound weight-loss for a person weighing 200 pounds. Among those taking the higher dose, 48% lost 10% of their starting weight, approximately a 20-pound weight-loss for a person weighing 200 pounds.

Concerns: The most common side effects include dry mouth, constipation, and tingling sensations in the face, arms, hands and feet. Insomnia may occur if taken later in the day. Women who are pregnant or who are considering becoming pregnant should avoid Qsymia® for its potential to cause birth defects.

Liraglutide Injection (Saxenda®)

How does it work? Saxenda® is an injectable medication approved by the FDA in 2014 to treat type 2 diabetes. It works by increasing the body’s natural production of insulin, which helps regulate blood sugar levels. Additionally, it decreases the production of a hormone that opposes insulin, slows down the emptying of the stomach, and aids in controlling feelings of fullness.

Weight-loss: In a study involving individuals on Saxenda® for one year, 73% lost at least 5% of their starting weight (equivalent to a 10-pound weight-loss for someone weighing 200 pounds), while 41% lost at least 10% of their starting weight (a 20-pound weight-loss for someone weighing 200 pounds).

Concerns: The most common side effects include nausea, vomiting, diarrhea and constipation.

Semaglutide Injection (Wegovy®)

How does it work? Wegovy® is an injectable prescription medicine designed for adults with obesity or excess weight who also have weight-related medical problems, aiming to help with weight-loss. It is a glucagon-like-peptide-1 (GLP-1) receptor agonist that is engineered in the laboratory. This means Wegovy® imitates the naturally occurring GLP-1 hormone released by our intestines into our bloodstream within minutes after we ingest food.

Weight-loss: The effectiveness and safety of Wegovy® have  been demonstrated through the Semaglutide Treatment Effect for People with Obesity (STEP) program, involving 4,500 individuals worldwide affected by obesity or classified as overweight with co-existing medical conditions due to excess weight. Participants received lifestyle counseling and were randomly assigned either Wegovy® or a placebo for 68 weeks. In the Wegovy® STEP studies, the average weight-loss ranged from 15 to 17% of the participant’s starting weight. For someone weighing 230 pounds, this equates to 35 to 39 pounds lost. In the STEP 1 study, one third of participants lost at least 20% of their total weight.

Concerns: Wegovy® should not be used in patients with a history of severe allergic reactions to Semaglutide, as well as those with a personal or family history of medullary thyroid carcinoma or a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Common side effects include nausea, diarrhea, vomiting and constipation. Additionally, Wegovy® may lead to hypoglycemia (low blood sugar) if taken with certain diabetes medications such as sulfonylureas and insulin. Warnings include pancreatis, gallbladder problems, increased heart rate, acute kidney injury (due to hydration) and diabetic retinopathy (retinal damage in patients with diabetes).

Tirzepatide (Zepbound®)

How does it work? Zepbound® is an injectable medication that mimics the naturally occurring GIP and GLP-1 hormones released by the intestines into the bloodstream within minutes after we ingest food. These gut hormones help regulate blood sugar, slow down the emptying of the stomach and control appetite.

Weight-loss: In four SURMOUNT studies of individuals taking Zepbound® for 72 to 88 weeks, the average weight-loss was 15-25% of the individual’s starting weight. This is a 30-50-pound weight-loss for someone weighing 200 pounds. In the SURMOUNT-1 study, more than one-third of individuals lost at least 25% of their weight while taking the 15 mg dose.

Concerns: Zepbound® should not be administered to patients who have a history of severe allergic reactions to Tirzepatide, or to those with a personal or family history of medullary thyroid carcinoma, or individuals with a rare condition known as Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

The most common side effects include nausea, diarrhea, constipation and vomiting. Zepbound® also contains warnings for severe stomach problems, kidney injury, gallbladder problems, inflammation of the pancreas(pancreatitis), changes in vision in patients with type 2 diabetes, and depression or thoughts of suicide.

Over-the-Counter-Drugs

Alli® is the only FDA-approved over-the-counter drug for weight-loss. It is not recommended for children under 18 years of age or adults with a BMI below 25. It’s important to talk with your healthcare provider before taking Alli®, just like with any new medication.

How does it work? Alli® is a lower-dose version of the prescription drug Xenical® (orlistat), taken before meals to reduce fat absorption. About 25% of the fat consumed isn’t absorbed, passing through as bowel movements. Alli® complements a healthy lifestyle, included a balanced diet, regular exercise and adequate hydration by drinking plenty of water. Resources and support are available at MyAlli.com.

Weight-loss: The average weight-loss with alli® is about five to ten pounds over six months. It is designed to increase your weight-loss while you focus on living a healthy lifestyle. For example, if you’ve already lost five pounds through diet and exercise, supplementing with alli® may help you lose two to three more pounds, totaling seven to eight pounds lost.

Concerns: A balanced diet containing some dietary fat is necessary for alli® to be effective. You will not see much a difference with your weight if you are already following a strict low-fat and low-calorie diet. Regular use of alli® may require a multivitamin to prevent nutrient deficiencies. Side effects are limited to the gastrointestinal system and may include gas, cramps, stool leakage, oily spotting and gas with discharge. However, they tend to go away with reduced fat intake.