Think Long-Term
Let’s use the example of a very common condition like high blood pressure: many of us take medicine to reduce our blood pressure, but we are aware that if the medicine is stopped, our blood pressure is likely to go back up. Yes, there are ways that our lifestyle (nutrition, activity, sleep and stress) can impact our blood pressure, but often it’s our hormones – programmed by our biology and genetics – that stubbornly keep our blood pressure up. Using well-studied medications alongside a good lifestyle plan is often the most effective way to control blood pressure. Weight is no different!
For decades, people have lost weight and then struggled to keep it off. What happens? The mix of hormones in our body gets out of whack: we get hungrier and find it harder to stay full. Slowly but steadily, our weight begins to increase again. Just like with blood pressure, we now have a series of rigorously tested medications that keep our hunger and fullness cues in a better balance – and if we stop that medicine once we’ve lost weight, we’re very likely to get hungrier and see our weight go back up. In sum, we don’t take medication simply for weight loss: we take medication to lose weight AND then we stay on medication to keep it off!
Let’s use the example of a very common condition like high blood pressure: many of us take medicine to reduce our blood pressure, but we are aware that if the medicine is stopped, our blood pressure is likely to go back up. Yes, there are ways that our lifestyle (nutrition, activity, sleep and stress) can impact our blood pressure, but often it’s our hormones – programmed by our biology and genetics – that stubbornly keep our blood pressure up. Using well-studied medications alongside a good lifestyle plan is often the most effective way to control blood pressure. Weight is no different!
For decades, people have lost weight and then struggled to keep it off. What happens? The mix of hormones in our body gets out of whack: we get hungrier and find it harder to stay full. Slowly but steadily, our weight begins to increase again. Just like with blood pressure, we now have a series of rigorously tested medications that keep our hunger and fullness cues in a better balance – and if we stop that medicine once we’ve lost weight, we’re very likely to get hungrier and see our weight go back up. In sum, we don’t take medication simply for weight loss: we take medication to lose weight AND then we stay on medication to keep it off!
Guideline-Directed Therapy
Under current medical guidelines, medication(s) can be prescribed to assist with weight loss in patients with a body mass index (BMI) greater than 30 kg/m2. A patient also qualifies by guidelines if they have a BMI greater than 27 kg/m2 and a weight-related condition such as type 2 diabetes or pre-diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, metabolic-associated steatotic liver disease (previously known as fatty liver disease), polycystic ovary syndrome, idiopathic intracranial hypertension, or knee or hip osteoarthritis.
FDA-Approved Medications
Below is a list of pertinent details about each of the most commonly used medications for weight management. For full prescribing information, please use the website listed for each medication as the most definitive source.
For more in-depth answers to general questions about how we prescribe medications, please visit our Weight Management page and scroll to the bottom.
Tirzepatide (Zepbound)
- Delivery and Frequency: Subcutaneous (under the skin) injection once per week
- Dosing: 2.5mg/week to start, 15mg max (interval doses: 5mg, 7.5mg, 10mg, 12.5mg)
- Expected Weight Loss (average): 21% total body weight (16% in type 2 diabetes)
- Co-Indications: Type 2 diabetes (Mounjaro), moderate or severe obstructive sleep apnea
- Contraindications: Pregnancy, personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2
- Most Common Side Effects: Nausea/vomiting, constipation, diarrhea, fatigue, indigestion/reflux, injection site reaction (full list of side effects can be found here)
- Cost: Please visit the manufacturer’s website for the most comprehensive and up-to-date information.
Semaglutide (Wegovy)
- Delivery and Frequency: Subcutaneous (under the skin) injection once per week
- Dosing: 0.25mg/week to start, 2.4mg max (interval doses: 0.5mg, 1mg, 1.7mg)
- Expected Weight Loss (average): 15% total body weight (10% in type 2 diabetes)
- Co-Indications: Type 2 diabetes (Ozempic), cardiovascular risk reduction (Wegovy) for BMI > 27 with prior heart attack, stroke, or symptomatic peripheral arterial disease
- Contraindications: Pregnancy, personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2
- Most Common Side Effects: Nausea/vomiting, constipation, diarrhea, fatigue, indigestion/reflux, injection site reaction (full list of side effects can be found here)
- Cost: Please visit the manufacturer’s website for the most comprehensive and up-to-date information.
Phentermine-Topiramate XR (Qsymia)
- Delivery and Frequency: Pill taken by mouth once daily
- Dosing: 3.75-23mg to start, 15-92mg max (interval doses: 7.5-46mg, 11.25-69mg)
- Expected Weight Loss (average): 10-12% total body weight
- Co-Indications: Phentermine (none, see below); Topiramate (see below)
- Contraindications: See phentermine and topiramate individual listings
- Most Common Side Effects: See phentermine and topiramate individual listings (full list of side effects can be found here)
- Cost: Per the mail-order pharmacy affiliated with the manufacturer (Qsymia is only cheaper at a retail pharmacy if covered by insurance)
Phentermine (Lomaira, Adipex)
- Timing and Delivery: Pill taken by mouth once, twice, or three times daily
- Dosing: 8mg to start, 37.5mg total max daily dose (interval doses: 8mg up to 3x daily, 15mg or 30mg once daily)
- Expected Weight Loss (average): 7-8% of total body weight
- Co-Indications: None – stimulant properties may assist with energy level or concentration
- Contraindications: Pregnancy, prior heart issues, hyperthyroidism, history of severe mental health concerns such as bipolar disorder or schizophrenia, history of drug abuse
- Most Common Side Effects: Dry mouth, increased heart rate, increased blood pressure, insomnia, headache, dizziness (full list of side effects can be found here)
- Cost: 8mg dose coupon here; higher doses are generic, cost varies
Topiramate (Topamax, Trokendi)
- Delivery and Frequency: Pill taken by mouth up to four times daily
- Dosing: 25mg to start, 400mg max (with many interval dosing and frequency levels)
- Expected Weight Loss (average): 7-8% of total body weight
- Co-Indications: Migraine prevention, seizures
- Contraindications: Pregnancy, memory or cognitive concerns, kidney stones, angle-closure glaucoma
- Most Common Side Effects: Memory issues or foggy thinking, paresthesias (tingling), metabolic acidosis (full list of side effects can be found here)
- Cost: Sometimes covered by insurance for a co-indication (e.g., migraines); cost can vary by pharmacy, but may be found for around $10-15 per month
Naltrexone-Bupropion (Contrave)
- Delivery and Frequency: Pill taken by mouth, up to two pills twice daily
- Dosing: 8-90 mg (1 tab) to start, 2 tabs twice daily max (interval doses: 1 tab twice daily and 2 tabs AM + 1 tab PM)
- Expected Weight Loss (average): 6-8% of total body weight
- Co-Indications: Bupropion: Smoking cessation, depression; Naltrexone: alcohol use disorder and opioid dependence
- Contraindications: Bupropion: Pregnancy, seizure history; prior suicidal ideation; Naltrexone: Ongoing opiate use
- Most Common Side Effects: Bupropion: Headaches, insomnia, dry mouth, nausea, increased heart rate, increased blood pressure / Naltrexone: Nausea, constipation, headaches (full list of side effects can be found here)
- Cost: Per the mail-order pharmacy affiliated with the manufacturer (Contrave is only cheaper at a retail pharmacy if covered by insurance)
