GLP-1 Weight Loss Medications: Exploring the Other Options

Listening to current media it may seem like weight loss drugs did not exist before the advent of GLP-1 medication, but there are other options. For many patients GLP-1s are not good options and sometimes even with close physician guidance they are not tolerated. In certain individuals like those with a history of multiple endocrine neoplasia syndrome type 2 (MEN2) or a personal or family history of medullary thyroid cancer (MTC) we avoid GLP-1 medications altogether. When patients find out they are not candidates or that GLP-1s are not ideal for them they can feel hopeless. Mission Metabolic Health can safely and effectively help you navigate the available alternatives to GLP-1 medications for weight loss. Below is a brief discussion of some other options available. Also, we must keep in perspective the foundational changes that lead to weight loss and lean mass gains and not overlook the importance of diet and exercise even when we use medications to help.

While phentermine is effective, it has side effects and is a controlled substance, physician guidance is critical in monitoring and planning with this medication.

Phentermine (Adipex)

Phentermine is a sympathomimetic amine that acts as an appetite suppressant. It is one of the oldest and most widely prescribed weight loss medications. A study by Munro et al. found that phentermine alone led to a mean weight loss of 6.6% over 28 weeks, compared to 1.8% with placebo. While phentermine is effective, it has side effect potential and is a controlled substance, physician guidance is critical in monitoring and planning with this medication.

Combination Phentermine and Topiramate (Qsymia)

The combination of phentermine and topiramate, marketed as Qsymia, is effective in promoting weight loss. Topiramate is an anticonvulsant that is believed to modulate dopamine, GABA, and glutamate pathways, contributing to appetite suppression. A study by Lei et al. found that phentermine-topiramate was effective in reducing body weight, waist circumference, blood pressure, lipid levels, and plasma glucose levels.

Bupropion and Naltrexone (Contrave)

The combination of bupropion, an antidepressant, and naltrexone, an opioid receptor antagonist, is marketed as Contrave for weight loss. This combination targets the pleasure-reward areas of the brain, decreasing cravings and appetite. According to a study by Khera et al., 55% of participants taking naltrexone-bupropion achieved 5% weight loss, compared to 23% of those taking a placebo.

Orlistat (Xenical, Alli)

Orlistat is a lipase inhibitor that blocks the absorption of dietary fat, thereby reducing caloric intake. It is available in prescription (Xenical) and over-the-counter (Alli) forms. While orlistat can promote modest weight loss, it does not directly suppress appetite or increase energy expenditure.

Orlistat is a medication that we rarely use in practice at MMH. We are focused on quality of life and orlistat can compromise that because of its side effect profile. Orlistat has potential gastrointestinal side effects, such as oily stools, flatulence, and fecal incontinence, especially when dietary fat intake is high.

Non-GLP-1 weight loss medications, such as phentermine, combination phentermine and topiramate, bupropion and naltrexone, and orlistat, can be effective tools in the management of obesity. Our physician specializes in Obesity management and has the expertise to administer these options effectively. MMH is focused on management of your overall current and long term health. Any weight loss drugs should be tailored to individual needs and monitored closely for optimal results and safety, that is our focus.

References:

Munro, J. F., et al. "Weight Loss with Phentermine and Topiramate Extended-Release in Obese Adults." Obesity, vol. 19, no. 11, Nov. 2011, pp. 2207–13. Crossref, https://doi.org/10.1038/oby.2011.125.

Lei, Y., et al. "Efficacy and Safety of Phentermine-Topiramate for the Treatment of Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Obesity Reviews, vol. 22, no. 9, Sept. 2021, p. e13293. Crossref, https://doi.org/10.1111/obr.13293.

Khera, Rishi, et al. "Naltrexone/Bupropion for Obesity: An Evidence-Based Review." Obesity Science & Practice, vol. 5, no. 3, June 2019, pp. 237–50. PubMed Central, https://doi.org/10.1002/osp4.331.

Khera, Rishi, et al. "Pharmacotherapy for Obesity: A Systematic Review and Meta-Analysis of Monotherapy and Combination Regimens." Obesit