What kind of weight loss pills are safe and reliable?

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What kind of weight loss pills are safe and reliable? Orlistat, Metformin, Liraglutide… Which one is better?

What kind of weight loss pills are safe and reliable?  When is the medication recommended?

In addition to meeting a more beautiful self, losing weight can also prevent various chronic diseases. Because obesity itself is not only a chronic disease state, but also a risk factor for various chronic non-communicable diseases.

Fortunately, obesity can be prevented and controlled. At present, the main clinical management and treatment of obesity include lifestyle intervention, weight-loss drugs and bariatric surgery.

We know that diet and exercise are the preferred ways to lose weight. If lifestyle intervention is not effective, can you take some medicine to make weight loss more effective?

When is the medication recommended?

According to the 2018 expert consensus on weight management for overweight or obese people and the recommendations in the group standards, if lifestyle intervention does not achieve at least 5% weight loss within the first 3 to 6 months, individuals with obesity or overweight with complications can start drugs Treatment [3]. In other words, if a person of 200 kg loses less than 10 kg within 3-6 months of diet and lifestyle intervention, it is recommended to use drugs to assist in weight loss.

In addition, the American Endocrine Society recommends that when the 5% weight loss goal is not reached within 3 months of full dose of the drug, weight loss drugs should be stopped and the patient should be reassessed [4].

What are the weight loss drugs?

brief introduction to weight loss drugs in various countries.

Orlistat

The content of lipase in obese people is relatively high. Orlistat can selectively inhibit pancreatic lipase activity and reduce the absorption of about 30% of the fat in the diet. Yes, the literature says only 30%! After taking the medicine, I want to loosen or feel greasy stools, which is actually an adverse reaction caused by the medicine [5]. This kind of gastrointestinal adverse reaction will result in eating less, and the medicine itself will also reduce the absorption of calories (the main reason), so many people think this medicine seems to be good.

It is better to control your diet and enhance exercise while taking weight-loss pills. Clinical trials have shown that for overweight or obese patients with type 2 diabetes, on the basis of a lower-calorie diet, after 24 weeks of treatment with orlistat (120mg, 3 times a day), they lose more weight than just diet intervention (5.4kgVs2.4kg). Although some studies have shown that there is no significant difference in the effect of the drug in the treatment of weight loss, more studies have shown that exercise combined with orlistat has a better effect [6].

Moreover, the combination of dietary therapy and orlistat has a significant effect on obese patients with endocrine disorders and obese type 2 diabetes patients, and can reduce blood pressure, regulate blood lipids, and reverse or alleviate the development of diabetes to a certain extent.

Does it feel like this medicine can’t be too good?

But it should be noted that in addition to the gastrointestinal discomfort mentioned at the beginning, orlistat can also affect the absorption of some drugs and nutrients while inhibiting the absorption of fat. For example, it affects the effects of cyclosporine, levothyroxine, hypoglycemic drugs, warfarin, lamotrigine and other drugs and the absorption of fat-soluble vitamins (vitamins A, D, E, K). Therefore, it may be necessary to take a multivitamin preparation daily while taking the medicine. In addition, the long-term cardiovascular risk of orlistat is unclear.

Metformin (Metformin)

Metformin is a classic type 2 diabetes first-line treatment that has been used clinically for more than 60 years. Although a number of studies have shown that it can bring weight loss benefits, it has not been officially approved as a weight loss drug.

Many people think that it is the most affordable weight loss drug, the key medical insurance can still be reported, you can eat secretly, quietly lose weight! Is it really?

A review of 21 studies [7] that targeted different groups of people taking metformin treatment showed that: metformin has a moderate reduction in participants’ BMI, and it is most significant in people with simple obesity. Compared with before treatment, metformin treatment significantly reduced the BMI of obese patients with BMI>35kg/㎡. The BMI of the high-dose group dropped by 1.01 units, and the BMI did not continue to decrease significantly after treatment for more than 6 months.

However, whether the value of weight loss is sufficient (5% of baseline body weight) to meet the “obesity drugs” required by the current guidelines requires larger randomized controlled trials.

In addition, metformin is also used to treat the sequelae of obesity, such as hepatic steatosis, obstructive sleep apnea, and osteoarthritis. Its effect may be to reduce liver gluconeogenesis and reduce insulin resistance; there is also evidence that metformin-related weight loss is due to the regulation of the appetite regulation center of the hypothalamus, changes in the gut microbiome, and reversal of the consequences of aging [8].

Looks great?

But in fact, you may not be able to bear the side effects of this drug. The most common is that after taking the medicine, it may cause diarrhea, nausea, vomiting, abdominal distension, and abdominal pain; long-term use may affect the absorption of vitamin B12, damage the nervous system, and even anemia; severe cases may cause lactic acidosis.

Semaglutide

Semaglutide (formerly known as Semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist, which can stimulate the production of insulin, inhibit the secretion of glucagon, and reduce appetite And food intake.

On June 4, 2021, the US FDA approved smegaglutide for the treatment of obesity, as a low-calorie diet and an auxiliary means of strengthening exercise. For adult patients who are obese (BMI≥30kg/㎡) or overweight (BMI≥27kg/㎡) accompanied by at least one weight-related comorbidity, the initial dose of the drug is 0.25mg/weekly, and the dose after 4 weeks Gradually increase to 2.4mg/weekly [9].

Data show that the weight loss effect of smeglutide in the treatment of simple obesity is about 15%, and it is safe and well tolerated. The most common side effect is gastrointestinal reactions. Symptoms such as dizziness, nausea, constipation, and insomnia may also occur.

Liraglutide

Liraglutide is also a GLP-1 receptor agonist, while obesity treatment is an over-indication drug. Liraglutide (3.0mg/d) was approved by the FDA for weight management in 2014. It is suitable for overweight or obesity accompanied by at least one weight-related disease such as high blood pressure, type 2 diabetes or high cholesterol (dyslipidemia) Of adults.

A 56-week trial covering 21 countries  showed that subjects in the diet combined with liraglutide group lost more weight (8.4kgVs2.8kg) compared with diet intervention alone. , P<0.001). Another study showed that a combination therapy strategy combined with exercise is more effective than exercise alone to lose weight or drug therapy alone.

Because liraglutide can inhibit the feeding center and affect the patient’s appetite; at the same time, it can delay gastric emptying and slow down the speed of food digestion and absorption, so as to achieve the purpose of diet control. Therefore, after injection of liraglutide, it is easy to cause gastrointestinal side effects such as abdominal distension, diarrhea, nausea, and vomiting.

Sibutramine

From the “Qumei” promoted in TV commercials in the early years, to the “random fruit” and “weight loss coffee” sold on Internet platforms in recent years, to this year Guo Meimei was imprisoned for “weight loss candy” and sibutramine The figure seems to have not dissipated. But it was indeed banned by various countries for a long time because of its extremely lethal side effects.

Sibutramine is a central nervous system depressant. It was originally used to treat depression, but was later found to increase satiety and suppress appetite, while at the same time it can promote metabolism and break down fat. Therefore, it was approved by the US FDA in 1997 for weight loss and maintenance of weight loss in patients with BMI ≥ 30 kg/㎡ or BMI ≥ 27 kg/㎡ . 

In 2003, it was discovered that the risk of adverse cardiovascular events after taking sibutramine was greater than weight loss. The data showed that compared with taking placebo, the relative risk of non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, and cardiovascular death caused by taking sibutramine increased by 16% (p= 0.02). Therefore, countries around the world announced to stop the production, sales and use of sibutramine preparations and APIs [11].

Therefore, weight loss coffee, weight loss candy, weight loss tea, these products must be careful about the ingredients, it is best not to eat casually under the premise of uncertain ingredients and principles.

Setmelanotide

Some obesity is rare genetic obesity caused by certain single gene mutations. This condition shows severe clinical symptoms in the early stage of onset. However, there are currently no indications for weight loss drugs for this type of disease worldwide. For example, promelanocortin (POMC)-deficient obesity and leptin receptor-deficient obesity are two important types of this rare genetic obesity.

Semelanotide is a melanocortin 4 receptor (MC4R) agonist. It has shown good efficacy and safety in clinical trials for rare obesity. It is expected to be used in clinical trials after obtaining marketing approval in the United States. 

In summary, Metformin, liraglutide, and smeglutide may be suitable for obese patients with type 2 diabetes.

Although each of the above-mentioned drugs has more or less side effects, it can still be used according to the evaluation of clinicians. Special reminder, do not eat any products containing sibutramine.

However, the best choice for people who are overweight or obese is still to adjust their diet and lifestyle first, whether or not to use medicine, and what kind of medicine to use, please consult a professional doctor, don’t make your own claim, you don’t know what to do, you know…

(source:internet, reference only)

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