Someday I’ll discover the secret ingredients for a magical pill which, when taken, gives all the benefits of exercise without any of the accompanying pain. I’ll call it “Exercise in a Bottle.” One red pill equals 30 sit-ups. One green pill equals a two mile run. Of course, your co-workers will wonder how you worked up such a sweat just sitting in your swivel chair, chomping on chips. But those wary glances will be more than compensated for as your friends watch your weight virtually fall off before their eyes.
Actually, the idea isn’t entirely impossible, as some studies have been done on mice using a metabolism-stimulating substance known as AICAR (aminoimidazole carboxamide riboside) with promising results. But this article isn’t about the future, it’s about now. And according to market research done just this month, public awareness of the latest prescription medications for weight loss is still very low. So I thought I would take a few moments to introduce two newcomers, Belviq® and Qsymia®, to my readers.
Belviq® (lorcaserin hydrochloride) is a prescription medication approved by the FDA in mid-2012 for individuals with a BMI (body mass index) over 30, or for those with a BMI over 27 with other health risk factors such as diabetes. It is a tablet (10mg), and is typically taken twice daily. Common side-effects include headache, dizziness and fatigue. It appears to work by very selectively stimulating receptors in your brain that make you feel full sooner than usual. How well does it work? In one study weight loss was about 7.24 pounds more than diet and exercise alone.
Qsymia® is a combination of two ingredients, each of which is currently available separately for different purposes and developed by Vivus pharmaceuticals. The first ingredient, phentermine, is an appetite suppressant that works by stimulating the release of a brain chemical known as leptin. The other ingredient is most often prescribed as an anti-seizure treatment known as topiramate. Together they appear to work in harmony to reduce cravings and promote weight loss. Like Belviq®, it is only indicated for individuals who meet certain BMI standards. Common side effects include dizziness, insomnia and constipation. 70% of patients on Qsymia successfully lose 5% or more of their starting body weight according to available studies.
Both of these new medications are effective for some patients. Both are expensive, running you over $200 per month without insurance (and many plans don’t cover them). Both have coupons and deals available if you visit their respective websites. And both have side effects and drug interactions to be aware of.
Should you consider talking to your doctor about them? As a pharmacist I often get asked questions about weight loss products and supplements. Pharmacies often devote many shelves of space to market products that claim to shed pounds and tighten tummies. The vast majority of these products, particularly those available without a prescription, have very little evidence to substantiate their claims.
THE 5 A’S OF MAINTAINING A HEALTHY WEIGHT:
My advice to all patients, prior to thinking about any pills or programs for weight loss, is to focus on what I call the 5 A’s of Maintaining a Health Weight:
Awareness – Increase your awareness of what you eat by writing it down. Note, particularly, if there seems to be too many carbohydrates (breads, pasta, sugars) in your diet. This is critical, especially at the beginning. People sometimes ask if they really have to write down “everything.” I tell people: if it has even 1 calorie, it goes in the book. Pick up an inexpensive memo book of some sort.
Activity – Keep an activity journal too. Try to change up your routine. Take more walks. Do things you enjoy. This can and should be the same notebook used above to record the food you eat. Note: always talk to your physician before beginning a new exercise routine if you have any health conditions which might be impacted by your activity.
Accountability – Ideally find someone else to partner with as you seek to lose weight. Although many people can do this successfully alone, it is always more encouraging to do it with others. Maybe start a little walking club with a few friends. Having a friend is helpful because we are much more prone to give up by ourselves.
Aqua – Water. Drink it. Unless otherwise restricted, try and get in 8 full (8 oz.) glasses every day. Yes, I know the “8 glasses, 8 ounces” rule isn’t written in stone anywhere. But it is a good goal to aim for, and will make you feel more food and help stimulate your metabolism.
Attitude – The way we think about food sometimes needs to change. Don’t use food simply to make you feel better. Rather, use the foods you really like to motivate you and as rewards for levels of success.
When these things have been done, and you still find yourself struggling, then it may be time to talk to your physician about other options, which may include medications. In the meantime, I’ll keep searching for our exercise in a bottle!
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