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Best diet pills/medication does not exist, just like there are no “best golf clubs”, “best purses”, or “best automobiles”. Every individual has different reasons for their gain and different responses to each medication. Each weight loss medication works on different areas of the body to control appetite, cravings and fullness often in different ways. The secret is to match the “right medication” to the “right person.”
How to Pick Best Prescription Diet Pill or Medication for Weight Loss
Despite these differences, there are many factors to help you and your physician when deciding on the best weight loss pills for you. Looking at all of 11 approved medications, phentermine is often the good choice. It is very effective, because phentermine dosage can be individualized for each dieter. Dr Lipman has written several short booklets on each of the most common weight loss medication including Qsymia, and Contrave. They are available on amazon.com and Dr Lipman’s app. Read a reviews of these Diet Medication Booklets.
Alternate weight loss medications include Topiramate, Contrave, Xenical, Plenity and the newly approved once a week injection –Wegovy. All of these medications produce weight loss, picking the best one for you is an individual process. All of these will help you get off weight loss plateaus.
Importance of FDA Approval for Weight Loss Medication
Currently 2/3 of adults and 1/3 of children in the US sare overweight or obese. Therefore, there is great pressure on Food & Drug Administration and the healthcare community—physicians and pharmaceutical companies alike—to develop new effective and safe treatments. The heart of all FDA medical product evaluation decisions is a judgment about whether a new product’s benefits to users will outweigh its risks. No effective product is totally risk or side effect free, so these judgments are important. Review side effects of weight loss medications such as mild insomnia. rare skipped or irregular heart beats and dry mouth.
Almost all medications become DEA controlled substances once the FDA approves them. There are several weight loss medications that are not controlled drugs including Contrave (a combination of wellbutrin(buproprion) and naltrexone, Plenity, Orlistat (Xenical), Topamax and Metformin and more recently Wegovy. Unfortunately, there are no FDA approved, effective drugs for weight loss that are Over the Counter, nor are any weight loss supplements proven to be effective.
Classification of Diet Medications: FDA Approved Medications
Medications Producing Weight Loss by Novel Mechanisms: (Not necessarily by appetite suppression)
There are several FDA approved medications that assist in weight loss by novel mechanisms NOT associated with appetite center stimulation such as Metformin, Topamax and Orlistat, Naltrexone and most recently Plenity and Wegovy. These medications have little to NO central nervous system stimulation.
Metformin: The most interesting of these is Metformin which is used in diabetics to control blood sugar. Metformin also improves metabolism. Metformin has been available for more than 20 years, is safe, is not a stimulant and can be taken indefinitely. Recent studies suggest that besides limiting cravings the reduction of sugar and insulin release by metformin results in less fat formation and thus weight loss. In a recent study of 154 non-diabetic subjects weight loss averaged 12 lbs over the 6 month study. The authors concluded that “metformin was an effective drug to reduce weight in a naturalistic outpatient setting in insulin sensitive and insulin resistant overweight and obese patients.” Another study found significant weight loss in many overweight adolescents .
Plenity: The weight loss pill Plenity was approved by the FDA in 2019 and has been available since September 2020. Plenity is a safe and effective weight loss agent that works by producing fullness in the stomach. It is NOT absorbed into the blood and has no effect on appetite or craving centers of the brain. This makes the drug ideal for millions of people in the US that cannot take ” phentermine- like” appetite suppressors because of medical problems.
Plenity works by expanding in the stomach and intestines. Taken 30 to 40 minutes before eating the capsules break apart and the resulting hydrodrogel cells absorb 100 times their weight from the water in the stomach. The result is that you feel full and have less room for food, thus you’re likely to eat less. After you eat, the hydrogel matrix moves out of the stomach, where it breaks down in the intestines and releases the water back into the intestines.
Plenity treated patients achieved weight loss of ≥ 5%, and 27% achieved ≥ 10% versus 42% and 15% in the placebo group, . Patients with prediabetes or type 2 diabetes had six times the odds of achieving ≥ 10% weight loss. Because the body doesn’t absorb the hydrogel — it passes through the gut and out the end of the GI tract — the FDA considers it to be a “device,” not a drug. It is available only online.
Orlistat: Orlistat (OTC version Alli) with a brand name of Xenical works completely different than other weight loss medications. It inhibits pancreatic enzymes responsible for the digestion of fats, permitting the fats to pass out thru the gastrointestinal tract and thus reducing calories.
Topamax: Topamax is an older FDA medication used for seizures and migraine headaches it can be taken alone or more commonly taken in the prescription weight loss medication Qsymia.
Naltrexone: Another FDA medication that has been used to reduce alcohol consumption and cravings for sweets resulting in reducing calories is Naltrexone. Naltrexone has been on the market for more than 20 years. it’s a very safe and effective medication especially for alcohol over-consumption. It works by blocking the opioid receptors in the brain which are activated by alcohol. Many individuals note reduction in need for sweet and salty comfort foods when taking Naltrexone.
Weight Loss Medications Acting on the Brain Appetite Centers
The FDA has tightly regulated the drug marketplace for weight loss medications. The vast majority of medications are not only prescription drugs but also DEA controlled substances because of their effect on the brain. The DEA classifies these drugs into five categories, or schedules: I, II, III, IV and V. From the DEA:
Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs have a high potential for abuse and the potential to create severe psychological and/or physical dependence. As the drug schedule changes– Schedule II, Schedule III, etc., so does the abuse potential– Schedule V drugs represents the least potential for abuse.
The diet medications Qsymia, phentermine (including Lomaira), diethylpropion, and phendimetrazine are Schedule IV drugs. This means there is little to no abuse or dependency potential. A cough medicine with small amounts of codeine would fall under Schedule V. Narcotic pain medications such as oxycodone and fentanyl, as well as amphetamine-based ADHD drugs such as Adderall and Ritalin are in Schedule II. There are several prescription medications including Contrave, and Wegovy that are not controlled medications.
Wegovy: Wegovy is the newest of the weight loss medication. It falls into a group of GLP-1 medications that were first used for diabetics. A side effect of the drug was unexpected weight loss. Given as a once a week injection it produces the greatest weight loss of up to 20% of starting weight. Side effects are limited to mild nausea and other GI symptoms. The weight loss effect is due to its effect directly on the appetite center of the brain as well as on the stomach producing delayed gastric emptying.
A newer, more potent version of Wegovy is Mounjaro released in May 2022.
- There are NO FDA approved prescription weight loss medications in over-the-counter (OTC) drug or supplement groups.
- There is only a single approved nonprescription medication for weight loss. It is called is Alli (Orlistat). Unfortunately, it is not very effective. Xenical is the prescription strength version of Orlistat.
- Wegovy, Xenical and Contrave are the only FDA-approved prescription weight loss medications that are not DEA controlled drugs.
Best Prescription Weight Loss Pills: Do I Qualify for Medication?
Weight loss pills are all medications requiring a prescription from a physician. Weight loss drugs may be an option for you if:
- You are obese (BMI of 30 or higher)
- You are overweight (BMI of 27 or higher) with serious health risks, such as high blood pressure, type 2 diabetes, or high cholesterol, and cannot control your weight with diet and exercise alone.
- Other medical conditions are present, such as sleep apnea, severe arthritis, and even depression.
Try our simple BMI calculator to discover your Body Mass Index
These BMI thresholds reflect a recommendation that individuals be treated when their body weight was at least 20% above “desirable weight” based on Metropolitan Life Insurance data from 1983. A BMI of ≈27 for men and women corresponded to being 20% above desirable weight and was associated with increased risks for hypertension (high blood pressure), hypercholesterolemia (high cholesterol), and diabetes mellitus, as well as premature death.
How to Determine Best Weight Loss Pills/Medications for You
Many factors go into the process of deciding which are the best weight loss pills for you. Assuming your weight and/or medical problems indicate the possible need for these medications, your medical history is the first place to start. This includes current medical problems, medications, past history of medical problems, and previous reactions to medications. Here are the is what you need to consider to find the best prescription diet pill for you:
1. Medical history that excludes use of prescription weight loss drugs:
Conditions include uncontrolled hypertension, heart failure, history of cardiovascular disease (heart attacks, TIA’s, strokes), terminal cancer, hyperthyroidism, and some cases of glaucoma.
2. Concurrent medications that exclude the drugs (Qsymia, Wegovy or Contrave):
MAO inhibitors, seizure medications, a history of allergy to any of these medications, or you are currently taking similar medication or one of the two components in Qsymia or Contrave. Dilantin, SSRI’s, methadone and opioid medications should not be used with contrave or Qsymia. Wegovy should not be used with insulin.
3. Past History of Successful Weight Loss Attempts with a Weight Loss Medication, or Unpleasant Side Effects
Your past attempts at weight loss with medications, successful or not, are often ignored when deciding the best weight loss pills for you. Older weight loss medications (diethylpropion and phentermine) have been on the market for more than 50 years, and the components of Qsymia and Contrave for almost equally as long. Your past responses, both positive and negative, can help you decide what new or old medication might be of assistance today.
Successful weight loss in the past with phentermine or diethylpropion might suggest trying these medications again at different dosages. It may also suggest Qsymia as a possible alternative. If you have been treated with bupropion (Wellbutrin) for anxiety or depression and noticed weight loss, you might consider Contrave. If you responded well to Zyban (a version of bupropion) and stopped smoking, you might also consider Contrave. Some dieters can lose up to a lb a day in the beginning.an stopped smoking, you might also consider Contrave. Some dieters can lose up to a lb a day in the beginning.
4. Your Age and Gender Often Help Decide the Best Weight Loss Pills:
Overweight and obese younger people (teens to mid-twenties) of both sexes and men who require weight loss medications but have never taken any of the older weight loss medications seem to do better when they take a single dose of the lowest dose medications in the morning. Older teens and men respond well to low dose phentermine or Tenuate, especially when the dosing is early in the morning and only once a day. Phentermine has been suggested to reset metabolism to higher levels in any of Dr Lipman’s 6 diet plans.
5. Your Tolerance (or Intolerance) for Side Effects Helps Determine Your Best Weight Loss Pills:
All of these medications have some side effects. Most are transitory and mild. However, everyone responds differently and side effects are unpredictable. In addition, everyone has a different tolerance for side effects. In general, Qsymia has the most side effects and at the same time is probably the most effective. Contrave has fewer side effects and is far less effective. Side effects fall into several groups:
- Insomnia, stimulation, anxiety: Typical of the older drugs like phentermine. Less frequent with diethylpropion. Not a problem with Lomaira 8mg.
- Somnolence and fatigue: Not seen in the older weight loss drugs. Most commonly experienced with Qsymia
- Tingling of fingers, memory problems: Seen only Qsymia because of the topiramate component.
- Gastrointestinal issues, including nausea and (rarely) vomiting: Only in Contrave due to the naltrexone component.
- Headache: Possible with all of the medications. Usually transient and tolerable. Responds to extra strength Tylenol.
- Nausea, stomach symptoms: see mostly with semaglutides Wegovy and Ozempic
6. Your Eating Patterns Help Determine the Best Weight Loss Pills for You:
You may be overeating for many reasons. Often, trying to analyze what, when, and how much you eat can help you decide on the best treatment. Here are several types of eating patterns and the medication that might be the best to consider:
- Compulsive Over-eater
A compulsive over eater is an individual who compulsively eats but does not purge and usually becomes overweight. The over eater may eat three meals a day plus frequent snacks. He or she thinks of food all day long. This person may overeat continually throughout the day rather than consume large amounts of food during intermittent binges. They tend to get stuck on the thought of food and feel compulsively driven. He or she tends to be a night time eater and typically claims to have no control over food. Often they worry and have difficulty falling asleep. This behavior has been associated with low levels of serotonin. Caffeine and older diet pills often make them anxious. The best weight loss pills for people in this category is often Qsymia (as long as they can tolerate the phentermine component) .
- Impulsive Overeating
An impulsive eater has poor impulse control and reaches for food often when he or she is not hungry and without thinking. They do well when they see healthy foods but have a hard time controlling urges when exposed to unhealthy foods. This is often seen in untreated ADHD. He or she has great difficulty adhering to a diet plan. This person will reach for the last piece of cold pizza slowly because it’s in front of them. Impulsive eaters usually reach for unhealthy food. The impulsive eating can occur day or night and is often unpredictable. The best weight loss pills for people in this category can be phentermine, diethylpropion, or Qsymia.
- Sad, Emotional, Anxious, or Depressed Overeating
Over-eaters with these emotional problems often overeat to calm down because they are depressed or sad. They often have depression and low self esteem. They will have feelings of negativity and hopelessness. The best weight loss pills for people in this category is often Contrave because of the effect of bupropion on depression. Belviq might also help when there are serious portion control problems as well. Medications working on serotonin in the hypothalamus of the brain seem better for this problem.
- Overeating is Associated with High Alcohol Consumption
Over eaters that are drinking 2 or more alcoholic drinks daily or almost daily can do very well with Contrave. This is especially true if there are elements of compulsive behavior and depression, and if the alcohol triggers increased appetite and lowering of inhibitions. The centers in the hypothalmus that control alcohol and food (especially carb) cravings are very close together.
Differences Among Prescription Weight Loss Medications
|Medication||Semaglutide, GIB, GLP||Phentermine and Topiramate||Naltrexone and Bupropion|
|Action||Decreases appetite, cravings -while increasing satiety by direct action on brain appetite center|
delays gastric emptying causing fullness
|Increases multiple chemicals throughout the brain to reduce hunger and cravings, and produce fullness||Increases impulses from PMOC neurons to reduce appetite|
|% of Subjects losing > 5% Body Weight||88%||66%||66%|
|Dosage||1 injection a week||4 dosages increasing over 3 months – 1 capsule per day||2 tablets twice a day|
|Time to Achieve Effective Dose||several months||10-14 days||3-4 weeks for full effect|
|Side Effects (see individual drugs)||nausea||Most due to side effects of topiramate and/or phentermine||Nausea, headache – self-limited, uncommon|
|Safety||Very safe||Pregnancy risk, otherwise safe||Very safe|
|Best For|| Can tolerate nausea as side effect, wants to avoid stimulating drugs||Willing to tolerate side effects to get fastest weight loss. Easy to individualize dosage. Use limited by side effects.||People with depression, history of cravings, heavy alcohol consumption. Dosage can be individualized.|
|Special Precautions||Few||Do not take if pregnant, nursing, or planning to become pregnant. People with heart disease and seizures should not take this medication.||Cannot take with SSRI’s or opioids|
Want to Read More About These Medications?
Learn More With Our Medication Quick Reference
Read Dr Lipman’s Book: Contrave, Qsymia or Belviq: Which is the Best New FDA Approved Weight Loss Medication?
5.0 out of 5 stars – A Smart Look At Some New Medications
Contrave, Qsymia or Belviq: Which is the Best New Medication? Is loaded with insight and a clear to understand direction to the secrets behind unlocking permanent weight loss. I really liked how sharp and clear Doctor Lipman is throughout the entire book. You have to keep up with what he is going over, but you never feel lost.
I had been considering bypass surgery, but due to some health issues started to see a lot of weight loss. After a year, and sixty-five pounds in weight loss, I am always looking to be informed about all the key tools and aids that can help, I don’t want to gain any back. I hope everyone reads up on all the new FDA approved medications, there are thousands of people that need to improve their health and get their weight under control.
It was encouraging to see the breakthroughs and better understanding of the different receptors that produce fullness, a sense of being satisfied, and the inner workings of cravings and how to reduce and control them. I also really liked all that is covered with each medication regarding the side effects, really helps you zero in on what might have the best results. A wonderful read, information that you can start to take action from and move forward with a clear understanding”.
By D Roberts on May 19, 2015
Call 305-670-3259 to Make an Appointment with Dr. Lipman in his Miami Office