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Weight loss drugs might sound like the easy option to take to lose weight. But you should consider other methods before using weight loss drugs. The best way of losing weight is the natural way - through dieting and exercise. However, some people struggle to lose weight. They do all the right things, but the weight does not come off.

If you are one of these people, then you might consider weight loss drugs to help achieve a clinical significant weight loss. Weight loss drugs are not meant to be used by the Jacks and Jills who just want to lose a few pounds for cosmetic reasons. You can benefit from weight loss drugs if you are obese, and this obesity is causing health problems.

Weight-loss drugs should not replace the need for changes in your eating habits or activity level.

Practitioners may recommend weight loss drugs to different classes of people including:

1. Patients with a body mass index (BMI) of 30 or more,
2. Overweight patients with a BMI of 27 or more who either lack “good” HDL cholesterol, have too much “bad” LDL cholesterol, are at risk of developing type 2 diabetes, have a high blood pressure, or have sleep apnea
3. People who have tried other weight loss methods, and failed

Common drugs available on the market

Some commonly available drugs are listed below. This list is by no means exhaustive. The first two are available on the NHS, if you meet their criteria.

• Sibutramine Meridia (US) /Reductil (UK)). This drug changes your brain chemistry, making you feel full more quickly. Typical dosage is 10 milligrams (mg) once a day. Possible side-effects include increased blood pressure, headache, dry mouth, constipation and insomnia.
• Orlistat (Xenical). Prevents the absorption of fat in your intestines. Normal dosage is 120 mg three times a day. Possible side effects include frequent oily bowel movements, diarrhea, bloating and abdominal pain.
• Rimonabant (Acomplia). Works by blocking the endocannabinoid system in the brain which regulates hunger. This stifles hunger and cravings. You take 1 pill a day. Possible side effects include dizziness, nausea, anxiety, diarrhea and insomnia.

During tests sibutramine and orlistat users typically achieved weight losses of 3-4 percent over a year. Rimonabant users typically achieved 5-10%, with almost 40% achieving 10% weight loss. Rimonabant is not expected to be on the NHS within the next two years due to its cost (£55 per patient per month).

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Background

Rimonabant (Acomplia, Zimulti), a selective cannabinoid-1 receptor (CB1) blocker, has been shown to reduce body weight and improve cardiovascular risk factors in obese patients. The Rimonabant in Obesity–Lipids (RIO-Lipids) study examined the effects of rimonabant on metabolic risk factors, including adiponectin levels, in high-risk patients who are overweight or obese and have dyslipidemia.

Methods

We randomly assigned 1036 overweight or obese patients (body-mass index [the weight in kilograms divided by the square of the height in meters], 27 to 40) with untreated dyslipidemia (triglyceride levels >1.69 to 7.90 mmol per liter, or a ratio of cholesterol to high-density lipoprotein [HDL] cholesterol of >4.5 among women and >5 among men) to double-blinded therapy with either placebo or rimonabant at a dose of 5 mg or 20 mg daily for 12 months in addition to a hypocaloric diet.

Results

The rates of completion of the study were 62.6 percent, 60.3 percent, and 63.9 percent in the placebo group, the group receiving 5 mg of rimonabant, and the group receiving 20 mg of rimonabant, respectively. The most frequent adverse events resulting in discontinuation of the drug were depression, anxiety, and nausea. As compared with placebo, rimonabant at a dose of 20 mg was associated with a significant (P<0.001) mean weight loss (repeated-measures method, –6.7±0.5 kg, and last-observation-carried-forward analyses, –5.4±0.4 kg), reduction in waist circumference (repeated-measures method, –5.8±0.5 cm, and last-observation-carried-forward analyses, –4.7±0.5 cm), increase in HDL cholesterol (repeated-measures method, +10.0±1.6 percent, and last-observation-carried-forward analyses, +8.1±1.5 percent), and reduction in triglycerides (repeated-measures method, –13.0±3.5 percent, and last-observation-carried-forward analyses, –12.4±3.2 percent). Rimonabant at a dose of 20 mg also resulted in an increase in plasma adiponectin levels (repeated-measures method, 57.7 percent, and last-observation-carried-forward analyses, 46.2 percent; P<0.001), for a change that was partly independent of weight loss alone.

Conclusions

Selective CB1-receptor blockade with rimonabant significantly reduces body weight and waist circumference and improves the profile of several metabolic risk factors in high-risk patients who are overweight or obese and have an atherogenic dyslipidemia.

Source Information: From the Quebec Heart Institute, Laval Hospital Research Center, and the Division of Kinesiology, Department of Social and Preventive Medicine, Laval University, Ste.-Foy, Que., Canada (J.-P.D.); the Service of Therapeutic Education for Chronic Diseases, University Hospital Geneva, Geneva (A.G.); and the Department of Body Composition and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden (L.S.). Full Article at The New England Journal of medicine Website

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