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Weight-loss drugs and your heart

Weight-loss drugs aren’t for people hoping to lose just a few pounds.

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Some first-generation diet pills proved risky to the heart. New drugs may have expanded the options for treating obesity.

Like high blood pressure and elevated cholesterol, excess weight can put a heavy burden on your heart. At least one in three adults is obese, a condition that boosts heart attack risk by about 60%.

Changing your eating and exercise habits can move your blood pressure and cholesterol numbers in the right direction; so can taking medication. But for losing weight, the pharmacological options are far more limited than those to lower blood pressure and cholesterol.

“The fundamental difference between obesity and other chronic diseases is that we don’t have a single drug that’s effective enough to treat most people,” says Dr. Lee Kaplan, who directs the Obesity, Metabolism, and Nutrition Institute at Harvard-affiliated Massachusetts General Hospital. Still, the approval of four new drugs in the past two years means there are now more potential options available.

Who’s a candidate?

Weight-loss medications are best used as part of a comprehensive weight-loss program that includes close monitoring by an experienced physician. You may be a good candidate if you

  • have a BMI higher than 30 ( see www.health.harvard.edu/bmi for a calculator ) or 27 or higher along with health problems related to your weight, such as type 2 diabetes, sleep apnea, high blood pressure, or chronic joint pain are overweight and eating a healthy diet and exercising but are unable to lose weight.

  • Compared with many other medications, weight-loss drugs have fairly modest effects: on average, they induce weight loss of about 5% over a period of six to 12 months. However, the response varies widely. A few people may lose a great deal on a particular drug, while others may lose little or none. But there’s no way to predict this response in advance, Dr. Kaplan says.

Factors to consider

In some cases, health conditions other than obesity influence medication choice. For example, a person with a fast heartbeat (tachycardia) or heart-related pain that occurs without warning (unstable angina) shouldn’t take phentermine (Adipex-P, Ionamin, others). This drug, which can speed up the heart and raise blood pressure, is still considered relatively safe, even for people taking blood pressure drugs. “But we require them to use a home blood pressure monitor, in case their blood pressure rises and we need to adjust their dose,” says Dr. Kaplan. (In 1997, two drugs related to phentermine, dexfenfluramine and fenfluramine, were taken off the market after they were linked to heart valve damage. A third, sibutramine, was removed in 2010 after a study found higher rates of heart attacks and strokes in users at risk for heart disease.)

People with type 2 diabetes might be considered for liraglutide (Saxenda), an injectable medication also used to treat diabetes. Those who have migraines might be started on Qsymia, which combines phentermine and topiramate (Topamax)—a drug used to treat both migraines and seizures. Contrave, a combination of naltrexone (Vivitrol) plus bupropion, may make sense for people with certain mood disorders or who are trying to quit smoking, as bupropion is also prescribed for depression (as Wellbutrin) and smoking cessation (as Zyban). Some doctors recommend orlistat (Xenical, Alli)—which works by blocking fat absorption in the gut—to people who eat high-fat diets. But there’s no evidence that such people respond better to this drug than to others.

People who lose at least 5% of their weight after three months can keep taking the drug. For people who don’t respond as well, Dr. Kaplan will typically prescribe a different drug, and may add several drugs together. “We continue until we find a regimen that’s most effective for each person,” he says.

FDA-approved weight-loss medications

Generic name (brand name)

How it works

liraglutide (Saxenda)

Mimics a hormone made in the intestines that signals
a sense of fullness to the brain

lorcaserin (Belviq)

Curbs appetite by stimulating brain receptors for chemicals that regulate fullness and metabolism

naltrexone and bupropion (Contrave)

Affects the brain’s impulse, reward, or hunger centers, which may lower appetite and the reflex to eat food for comfort

orlistat (Xenical, Alli*)

Cuts fat absorption in the intestine by up to 30%

phentermine
(Adipex-P, Ionamin, others)

Boosts levels of brain chemicals that make you feel full and speeds up metabolism

phentermine and topiramate (Qsymia)

See above; may also affect brain chemicals that suppress appetite and stimulate a feeling of fullness

* Alli is a lower-dose version of orlistat available over-the-counter.

Posted by: Dr.Health

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