Maintaining a healthy weight is a battle for many people. Getting older, a sedentary lifestyle, your work environment, and an unhealthy diet can all contribute to weight gain and obesity.
Overweight and obesity are both terms for a range of weight that is greater than what is considered healthy for a given height. Being obese or overweight means you have an excess of body fat. Obesity can shorten your lifespan and increase your risk for many different health conditions, including:
- High cholesterol
- Heart disease
- High blood pressure
- Stroke
- Sleep apnea
- Type 2 diabetes
- Some types of cancer.
The good news is that addressing weight problems can prolong your lifespan and may help to prevent or even reverse certain medical problems. Even losing 10% of your weight can translate into positive health benefits in many cases.
Often, diet changes and increased regular exercise are the first choices recommended. Today, some weight loss medicines, called GLP-1 receptor agonists, are being used more frequently and with greater success in many patients. If you are concerned about your weight, talk with your healthcare provider who has many choices to help you with weight management.
What causes obesity?
Obesity and being overweight are most often caused by unhealthy lifestyle choices, like eating too much, eating unhealthy foods and not exercising enough to burn those calories.
Other factors that can lead to weight problems include: your genetics and family history, being obese or overweight as a child, not getting enough sleep, certain health or hormonal conditions, or some medicines you take.
Consult with your doctor who can evaluate your daily routine, family history and health conditions to better formulate a safe and effective plan for your weight loss.
What are the symptoms of being obese or overweight?
In addition to excess weight, if you are overweight or obese, you may have:
- Trouble sleeping or daytime drowsiness
- Sleep apnea (irregular breathing that often stops briefly during sleep
- Trouble breathing or becoming short of breath
- Varicose veins
- Excessive sweating and intolerance to heat
- Arthritis (osteoarthritis) due to the added weight on your joints (especially the back, hips and knees)
- Increased risk of skin problems (like fungal infections) due to moisture accumulation in skin folds
- Liver problems
- Gallstones
- Depression or other mental health conditions
How is obesity diagnosed?
The Body Mass Index (BMI) is a tool that has been used to determine if you are overweight or obese. For most people, BMI correlates with their amount of body fat. Your doctor may use BMI, which is a calculation based on your height and weight, to determine your level of obesity. A BMI calculation is also used to determine if you qualify for weight loss drug treatment.
BMI is only a tool and should be used in conjunction with other health measures to evaluate your overall risk due to weight.
To calculate your BMI (using pounds and inches):
- Multiply your weight in pounds by 703, then
- Divide that answer by height in inches, then
- Divide that answer by height in inches again.
BMI Risk Categories
- Underweight - BMI less than 18.5
- Healthy weight (normal) - BMI between 18.5 to 24.9
- Overweight - BMI between 25 and 29.9
- Obese - BMI above 30
Where you carry your weight (for example, the belly or thighs) is also important when determining weight-related health risks. If most of your weight is carried around the waist (apple shaped), you may have a greater risk than if it is carried lower on your body (like in your hips or thighs). Having a waist size of more than 35 inches in women, or 40 inches in men, can increase your risk for health problems like a fatty liver, heart disease and type 2 diabetes.
Although BMI can be used for most people, it does have some limits. For example, BMI may not be the best tool if you are older or an athlete. The calculation may overestimate body fat in athletes and others with a muscular build. It may also underestimate body fat in older persons and others who have lost muscle.
Talk to your doctor about your BMI and what the best options are for weight loss in your specific situation.
How is being obese or overweight treated?
Weight loss can be achieved in many ways:
- By increasing your activity and exercise levels
- By lowering your calorie intake and choosing more healthy, low fat foods
- Behavior modification programs and support groups
- The addition of weight loss medications to diet and exercise
- In some cases, weight-loss procedures or surgeries like gastric bypass or a gastric sleeve.
In most people, lifestyle changes such as a lower calorie diet and increased exercise are the initial steps used for weight loss. Your healthcare provider may also have you meet with a registered dietician to learn how to make the best food choices. Behavior modification programs, support groups or counseling might also be used to help you change your current habits.
Weight loss medicines are typically used when these initial treatment options have not fully worked. You’ll still need to maintain your diet and increased activity levels even if you are prescribed weight loss medicines.
What are the differences between the weight loss drugs?
There are many different types of medicines approved for weight loss, and some work better or are safer than others. Common medicines used in the treatment of obesity include:
- Adipex-P, Lomaira (phentermine)
- Bontril PDM (phendimetrazine)
- Qsymia (phentermine and topiramate)
- Contrave (bupropion and naltrexone)
- Saxenda (liraglutide)
- Wegovy (semaglutide)
- Alli, Xenical (orlistat)
Adipex-P, Lomaira, Bontril PDM, and Qsymia are all oral anorexiants (appetite suppressants). They work in your brain by suppressing your appetite so you eat less. You may lose up to 5% to 10% of your weight over one year with appetite suppressants when used alongside diet and exercise.
- However, if you don’t have good results after 12 weeks of use, anorexiants probably won’t work for you.
- These medicines are stimulants (in the same class as amphetamines) and are classified as controlled substances due to a greater risk for abuse or misuse.
Contrave is a combination oral tablet thought to increase your metabolism, and suppress your appetite and central reward center (in your brain). It is not a controlled substance but does require a prescription from your doctor.
Saxenda and Wegovy are newer medicines classified as glucagon-like peptide-1 (GLP-1) receptor agonists (also called incretin mimetics). They are given by subcutaneous injection, either once daily (Saxenda) or once weekly (Wegovy).
- These types of medicines can help reduce your appetite which may help you eat less and lead to weight loss.
- They work by acting like a hormone found in your body that signals brain receptors involved in your appetite and food intake. It also slows down how quickly the stomach empties, which makes you feel fuller for a longer period of time. Weight loss results have been in the 15% to 20% range for these medicines.
Other agents, such as Ozempic (semaglutide), Mounjaro (tirzepatide) and Rybelsus (semaglutide) work similarly to Saxenda and Wegovy and may be used by some doctors in an “off-label” fashion to treat patients with obesity or who are overweight. At this time, these agents are approved to treat type 2 diabetes only, but may lead to weight loss in these patients.
- Unapproved, or "off-label" uses have not been approved by the FDA and are not found in the package labeling.
- However, some doctors may have had good experience using these agents in an off-label fashion, and it may be an accepted use even though not specifically listed in the label.
- Realize that your insurance company may not pay for a medicine when used for an off-label condition.
Alli (orlistat) is an over-the-counter (OTC) option for weight loss and is a lower-dose version of the prescription drug Xenical. Alli and Xenical are helpful with weight loss without affecting the brain or suppressing the appetite. This medicine works by inhibiting lipase, an enzyme in your pancreas that helps lower the absorption of fat. It is also used alongside diet and exercise for best effect.
What else can I do?
In addition to diet and exercise, other things you can do to improve your health while you are losing weight include:
- If you smoke, quit smoking to help protect heart and lungs
- Take your medicines as prescribed, even if you feel good.
- Stay up to date with your doctor appointments
- Limit or exclude alcohol intake (no more than 1 drink per day for females, 2 drinks per day for men). Some weight loss medicines cannot be used with alcohol; check with your pharmacist.
- Learn ways to manage your stress.
- Get adequate sleep.
Your healthcare provider is always your best medical expert, but you might consider joining the Drugs.com Weight Loss Support Group to discover others with similar medical questions and shared health values.
