Obesity: Should I take weight-loss medicine?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Obesity: Should I take weight-loss medicine?

Get the facts

Your options

  • Take prescription weight-loss medicine.
  • Don't take medicines.

Key points to remember

  • Being very overweight makes you more likely to have serious health problems, such as heart disease and type 2 diabetes.
  • Weight-loss medicines may be an option if you haven't been able to lose weight with diet and exercise and if:
  • Medicine may help you lose a small amount of weight. But without permanent changes in eating and exercise habits, most people gain weight again after they stop taking the medicine.
  • You must decide whether the benefit of taking a certain medicine outweighs its side effects. Side effects of weight-loss medicines include headaches, nausea, bowel problems, and increased blood pressure.
  • Weight-loss medicines are expensive and may not be covered by your health insurance.
FAQs

What are weight-loss medicines?

Most weight-loss medicines work by making you feel less hungry or making you feel full sooner, so you don't eat as much.

Weight-loss medicines include:

  • Sibutramine (Meridia).This medicine makes you feel full sooner.
  • Orlistat (Xenical).This drug prevents some of the fat calories you eat from being absorbed in your intestines. A weaker version of it, sold as Alli, is available without a prescription.
  • Phentermine . This drug keeps you from feeling as hungry. It is approved only for short-term use.

Weight-loss medicines are used along with diet changes and more physical activity. Without those lifestyle changes, you will gain the weight back if you stop taking the medicine.

Medicine doesn't work for everyone. If you don't lose weight within 4 weeks of starting the medicine, it will probably not help you.1

What are the risks and side effects of weight-loss medicines?

Weight-loss drugs are safer than they used to be, but they still have side effects that are sometimes serious. And experts don't know how safe or effective they are beyond 2 years of use.2

Side effects of weight-loss medicines

Sibutramine (Meridia)

Orlistat (Xenical)

Phentermine

  • Increased blood pressure and heart rate
  • Headache
  • Dry mouth
  • Constipation
  • Sleep problems
  • Changes in bowel habits, including:
    • Oily or fatty stool. The oil seen in a bowel movement may be clear, orange, or brown.
    • Stool or oily matter that leaks out when you pass gas, oily matter that leaks out even when you're not passing gas, and an urgent need to go to the bathroom. Research shows that this happens to 22 to 27 out of every 100 people. This means that 73 to 78 out of 100 do not have this side effect.3
    • Being unable to control bowel movements.

Sometimes these side effects go away after a few weeks. But often they don't. They're the main reason people stop taking this medicine.

  • Nervousness
  • Irritability
  • Sweating
  • Nausea
  • Headache
  • Dry mouth
  • Constipation
  • Sleep problems
  • Possible addiction

Most of these side effects are mild, and they usually improve with continued treatment.

If you are under a lot of stress, have an emotional illness such as anxiety or depression, or have an alcohol or drug problem, you need treatment for that problem before you use weight-loss medicine. If you don't treat it, you will have a harder time losing weight.

Why might your doctor recommend weight-loss medicine?

Your doctor may recommend weight-loss medicine if:

  • Your BMI is at least 30 (27.5 if you are Asian).
  • Your BMI is at least 27 and you have other problems related to your weight, such as:
  • You have tried for at least 6 months to lose weight with diet and physical activity.
  • You don't have untreated depression or another major mental illness, and you don't abuse alcohol.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take weight-loss medicines Take weight-loss medicines
  • Depending on the type of drug, you take a pill 1 to 3 times a day.
  • You also make permanent changes in your diet and physical activity level.
  • Possible side effects include:
    • Increased blood pressure.
    • Headache and dry mouth.
    • Constipation and sleep problems.
    • Unpleasant changes in bowel habits.
  • Unless you make permanent changes in your eating and exercise habits, you are likely to gain back the weight after you stop taking the medicine.
  • Taking sibutramine along with certain migraine medicines can cause very serious illness.
  • Weight-loss medicines are expensive and may not be covered by your health insurance.
Use only diet and exercise to lose weight Use only diet and exercise to lose weight
  • You make permanent changes in your diet and physical activity level.
  • Eating fewer calories while increasing activity is the way to lose weight that works best for most people.
  • You avoid the risks and side effects of taking weight-loss medicines.
  • You avoid the expense of taking medicine.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about using medicine for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was concerned about taking a weight-loss medication. I was worried about those stimulant diet pills that people took years ago that had such a questionable reputation. But after struggling to lose not even 5 lb (2.27 kg) over the past 8 months, I am now ready to see whether medications can add anything to the good habits I've tried to establish. I know the medication isn't going to be a magic bullet, but I hope it can give me that little extra help I seem to need.

John, age 50

I realize that I didn't gain my extra weight in just a few months, and I don't expect to be able to lose it all quickly. I want to get back to eating a more balanced diet again, and set a good example for my kids so that they don't develop poor eating habits as they grow up. I plan to start taking them for walks and introducing them to lots of outdoor activities that we can do together. I don't want to be on pills for the rest of my life; I need a long-term solution.

George, age 45

My sister has been taking a weight-loss medication for about 4 months now, and she has been on a low-fat diet. We have been walking together 3 times a week. She has lost about 10 lb (4.54 kg) already. I don't think I've lost any weight yet, even though I have been watching what I eat, too. I think if the medication gives me a little help towards losing those first few pounds, I have the good habits and will power to keep the weight off on my own.

Susan, age 42

I know several people who have taken appetite suppressants, and while they worked well for some people, they didn't seem to work at all for others. And the side effects of Xenical sound pretty unpleasant to me. I have made a few changes in my diet, and I am walking twice a week. I'm going to give myself at least a year of a balanced diet and exercise before I consider whether I want to try taking a medication.

Carla, age 40

For more information, see the topic Obesity.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take weight-loss medicine

Reasons not to take weight-loss medicine

I am desperate to lose weight, and I think medicine will help me.

I don't like the idea of taking medicine.

More important
Equally important
More important

I have tried diet and exercise, and I just can't seem to lose weight.

I want to keep trying diet and exercise before I start taking medicine.

More important
Equally important
More important

I'm not worried about the cost of medicine.

I don't think I can afford the cost of medicine.

More important
Equally important
More important

I think losing a little bit of weight is worth the side effects of medicine.

I don't think the side effects are worth the small amount of weight I might lose by taking medicine.

More important
Equally important
More important

Along with taking medicine, I'm willing to work hard to make permanent changes in my eating and exercise habits.

Medicines aren't worth it to me if I'll just gain the weight back without permanent lifestyle changes.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking weight-loss medicine

NOT taking weight-loss medicine

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Weight-loss medicine is all I need to lose lots of weight permanently.

  • True No, that's wrong. Medicine will probably help you lose just a small amount of weight. And unless you make permanent changes in your eating and exercise habits, you will likely gain back the weight after you stop taking the medicine.
  • False You're right. Medicine will probably help you lose just a small amount of weight. And unless you make permanent changes in your eating and exercise habits, you will likely gain back the weight after you stop taking the medicine.
  • I'm not sure It may help to go back and read "Key points to remember." Medicine will probably help you lose just a small amount of weight. And without permanent lifestyle changes, you will likely regain the weight after you stop taking the medicine.
2.

I may suffer unpleasant side effects if I take weight-loss medicine.

  • True That's right. Side effects of weight-loss medicines include headaches, nausea, bowel problems, and increased blood pressure. Some people stop taking the medicine because the side effects are too unpleasant.
  • False Sorry, you're wrong. Side effects of weight-loss medicines include headaches, nausea, bowel problems, and increased blood pressure. Some people stop taking the medicine because the side effects are too unpleasant.
  • I'm not sure It may help to go back and read "What are the risks and side effects of weight-loss medicines?" Some people stop taking the medicine because the side effects are too unpleasant.
3.

I am just a little overweight, so weight-loss medicine is probably a good choice for me.

  • True No, that's not right. Weight-loss medicine is usually only for people whose BMI is at least 30 (27.5 if you are Asian or 27 if you have a health problem related to your weight).
  • False Yes, you're right. Weight-loss medicine is usually only for people whose BMI is at least 30 (27.5 if you are Asian or 27 if you have a health problem related to your weight).
  • I'm not sure It may help to go back and read "Why might your doctor recommend weight-loss medicine?" The medicine is usually only for people whose BMI is at least 30 (27.5 if you are Asian or 27 if you have a weight-related health problem.)

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Kathleen M. Ariss, MS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Adam Husney, MD - Family Medicine

References
Citations
  1. Klien S, Romijin JA (2008). Obesity. In HM Kroneberg et al., eds., Williams Textbook of Endocrinology, 11th ed, pp. 1563–1587. Philadelphia: Saunders.
  2. Yanovski SZ, Yanovski JA (2002). Drug therapy: Obesity. New England Journal of Medicine, 346(8): 591–602.
  3. Arterburn DE, et al. (2008). Obesity in adults, search date February 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevience.com.

Obesity: Should I take weight-loss medicine?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Take prescription weight-loss medicine.
  • Don't take medicines.

Key points to remember

  • Being very overweight makes you more likely to have serious health problems, such as heart disease and type 2 diabetes.
  • Weight-loss medicines may be an option if you haven't been able to lose weight with diet and exercise and if:
  • Medicine may help you lose a small amount of weight. But without permanent changes in eating and exercise habits, most people gain weight again after they stop taking the medicine.
  • You must decide whether the benefit of taking a certain medicine outweighs its side effects. Side effects of weight-loss medicines include headaches, nausea, bowel problems, and increased blood pressure.
  • Weight-loss medicines are expensive and may not be covered by your health insurance.
FAQs

What are weight-loss medicines?

Most weight-loss medicines work by making you feel less hungry or making you feel full sooner, so you don't eat as much.

Weight-loss medicines include:

  • Sibutramine (Meridia).This medicine makes you feel full sooner.
  • Orlistat (Xenical).This drug prevents some of the fat calories you eat from being absorbed in your intestines. A weaker version of it, sold as Alli, is available without a prescription.
  • Phentermine . This drug keeps you from feeling as hungry. It is approved only for short-term use.

Weight-loss medicines are used along with diet changes and more physical activity. Without those lifestyle changes, you will gain the weight back if you stop taking the medicine.

Medicine doesn't work for everyone. If you don't lose weight within 4 weeks of starting the medicine, it will probably not help you.1

What are the risks and side effects of weight-loss medicines?

Weight-loss drugs are safer than they used to be, but they still have side effects that are sometimes serious. And experts don't know how safe or effective they are beyond 2 years of use.2

Side effects of weight-loss medicines

Sibutramine (Meridia)

Orlistat (Xenical)

Phentermine

  • Increased blood pressure and heart rate
  • Headache
  • Dry mouth
  • Constipation
  • Sleep problems
  • Changes in bowel habits, including:
    • Oily or fatty stool. The oil seen in a bowel movement may be clear, orange, or brown.
    • Stool or oily matter that leaks out when you pass gas, oily matter that leaks out even when you're not passing gas, and an urgent need to go to the bathroom. Research shows that this happens to 22 to 27 out of every 100 people. This means that 73 to 78 out of 100 do not have this side effect.3
    • Being unable to control bowel movements.

Sometimes these side effects go away after a few weeks. But often they don't. They're the main reason people stop taking this medicine.

  • Nervousness
  • Irritability
  • Sweating
  • Nausea
  • Headache
  • Dry mouth
  • Constipation
  • Sleep problems
  • Possible addiction

Most of these side effects are mild, and they usually improve with continued treatment.

If you are under a lot of stress, have an emotional illness such as anxiety or depression, or have an alcohol or drug problem, you need treatment for that problem before you use weight-loss medicine. If you don't treat it, you will have a harder time losing weight.

Why might your doctor recommend weight-loss medicine?

Your doctor may recommend weight-loss medicine if:

  • Your BMI is at least 30 (27.5 if you are Asian).
  • Your BMI is at least 27 and you have other problems related to your weight, such as:
  • You have tried for at least 6 months to lose weight with diet and physical activity.
  • You don't have untreated depression or another major mental illness, and you don't abuse alcohol.

2. Compare your options

  Take weight-loss medicines Use only diet and exercise to lose weight
What is usually involved?
  • Depending on the type of drug, you take a pill 1 to 3 times a day.
  • You also make permanent changes in your diet and physical activity level.
  • You make permanent changes in your diet and physical activity level.
What are the benefits?
  • Eating fewer calories while increasing activity is the way to lose weight that works best for most people.
  • You avoid the risks and side effects of taking weight-loss medicines.
  • You avoid the expense of taking medicine.
What are the risks and side effects?
  • Possible side effects include:
    • Increased blood pressure.
    • Headache and dry mouth.
    • Constipation and sleep problems.
    • Unpleasant changes in bowel habits.
  • Unless you make permanent changes in your eating and exercise habits, you are likely to gain back the weight after you stop taking the medicine.
  • Taking sibutramine along with certain migraine medicines can cause very serious illness.
  • Weight-loss medicines are expensive and may not be covered by your health insurance.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Obesity.

Personal stories about using medicine for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was concerned about taking a weight-loss medication. I was worried about those stimulant diet pills that people took years ago that had such a questionable reputation. But after struggling to lose not even 5 lb (2.27 kg) over the past 8 months, I am now ready to see whether medications can add anything to the good habits I've tried to establish. I know the medication isn't going to be a magic bullet, but I hope it can give me that little extra help I seem to need."

— John, age 50

"I realize that I didn't gain my extra weight in just a few months, and I don't expect to be able to lose it all quickly. I want to get back to eating a more balanced diet again, and set a good example for my kids so that they don't develop poor eating habits as they grow up. I plan to start taking them for walks and introducing them to lots of outdoor activities that we can do together. I don't want to be on pills for the rest of my life; I need a long-term solution."

— George, age 45

"My sister has been taking a weight-loss medication for about 4 months now, and she has been on a low-fat diet. We have been walking together 3 times a week. She has lost about 10 lb (4.54 kg) already. I don't think I've lost any weight yet, even though I have been watching what I eat, too. I think if the medication gives me a little help towards losing those first few pounds, I have the good habits and will power to keep the weight off on my own."

— Susan, age 42

"I know several people who have taken appetite suppressants, and while they worked well for some people, they didn't seem to work at all for others. And the side effects of Xenical sound pretty unpleasant to me. I have made a few changes in my diet, and I am walking twice a week. I'm going to give myself at least a year of a balanced diet and exercise before I consider whether I want to try taking a medication."

— Carla, age 40

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take weight-loss medicine

Reasons not to take weight-loss medicine

I am desperate to lose weight, and I think medicine will help me.

I don't like the idea of taking medicine.

More important
Equally important
More important

I have tried diet and exercise, and I just can't seem to lose weight.

I want to keep trying diet and exercise before I start taking medicine.

More important
Equally important
More important

I'm not worried about the cost of medicine.

I don't think I can afford the cost of medicine.

More important
Equally important
More important

I think losing a little bit of weight is worth the side effects of medicine.

I don't think the side effects are worth the small amount of weight I might lose by taking medicine.

More important
Equally important
More important

Along with taking medicine, I'm willing to work hard to make permanent changes in my eating and exercise habits.

Medicines aren't worth it to me if I'll just gain the weight back without permanent lifestyle changes.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking weight-loss medicine

NOT taking weight-loss medicine

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Weight-loss medicine is all I need to lose lots of weight permanently.

  • True
  • False
  • I'm not sure
You're right. Medicine will probably help you lose just a small amount of weight. And unless you make permanent changes in your eating and exercise habits, you will likely gain back the weight after you stop taking the medicine.

2. I may suffer unpleasant side effects if I take weight-loss medicine.

  • True
  • False
  • I'm not sure
That's right. Side effects of weight-loss medicines include headaches, nausea, bowel problems, and increased blood pressure. Some people stop taking the medicine because the side effects are too unpleasant.

3. I am just a little overweight, so weight-loss medicine is probably a good choice for me.

  • True
  • False
  • I'm not sure
Yes, you're right. Weight-loss medicine is usually only for people whose BMI is at least 30 (27.5 if you are Asian or 27 if you have a health problem related to your weight).

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Kathleen M. Ariss, MS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Adam Husney, MD - Family Medicine

References
Citations
  1. Klien S, Romijin JA (2008). Obesity. In HM Kroneberg et al., eds., Williams Textbook of Endocrinology, 11th ed, pp. 1563–1587. Philadelphia: Saunders.
  2. Yanovski SZ, Yanovski JA (2002). Drug therapy: Obesity. New England Journal of Medicine, 346(8): 591–602.
  3. Arterburn DE, et al. (2008). Obesity in adults, search date February 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevience.com.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: March 2, 2010

Author: Kathleen M. Ariss, MS

Medical Review: Adam Husney, MD - Family Medicine

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