Obesity is a complex, chronic medical condition that is effected by genetics, epigenetics, lifestyle and environment. The treatment of this chronic condition therefore requires a multimodal approach. In recent years the addition of effective medications as an option in this treatment paradigm has been a game changer for both clinicians and patients alike. Most of these medications work to suppress hunger and increase satiety at a lower volume. This is helpful in both the weight loss and weight maintenance phases. They can be used with lifestyle change and also pre- and post- surgery.
Each person needs to be individually assessed to select the appropriate weight loss methods, including medication options, for their specific situation. This can be impacted by other medications, past medical history and previous response to therapy. The cost of therapy also needs to be considered as several drugs do not have an approved indication in Australia for weight loss alone. These can still safely be prescribed but are not subsidized by the PBS.
There are several medications available in Australia for weight loss. Some of the more common include*:
With the generic name of Liraglutide, this medication was first used in diabetics but was found to also slow the gastrointestinal system and suppress hunger, even in non-diabetics. It is given by a daily, subcutaneous injection. It starts at a low dose which is slowly titrated up under the supervision of your doctor to ensure maximal benefit while monitoring for side effects. These commonly include nausea, abdominal discomfort and constipation. Contraindications to consider are a history of pancreatitis and thyroid cancer. This is not covered by the PBS and can cost around $300 a month (in 2022).
Semaglutide is similar to Liraglutide in its history and mode of action. It is also a subcutaneous injection but only needs to be given once a week. Its side effect and contraindications are also similar but has been found to be tolerated by patients very well. It also is not covered by the PBS and usually costs approximately $150 a month to purchase (in 2022). This medication has been widely discussed in the media of late due to shortages in supply. While it is not covered by the PBS and must therefore be purchased using a private script, it’s use is by no means limited to diabetics and is widely prescribed for weight management in Australia and overseas. Patients should discuss their eligibility for treatment directly with their doctor and not be made to feel guilty for accessing a reputable, effective management for their chronic medical condition.
This is a combination of two medications called Bupropion and Naltrexone. It is taken as a daily tablet with a dose dependent on the response. It works to change the brains signaling hormones to decrease hunger. It’s main side effects are nausea and constipation. It tends to cost approximately $250 a month (in 2022).
Phentermine is an appetite suppressant that works directly on the areas of the brain that control hunger and appetite. It is a daily oral tablet. It is contraindicated in the setting of many other medical conditions such as heart disease, arrythmia, cerebrovascular disease and glaucoma. Some patients find this a helpful medication but unfortunately many suffer insomnia before experiencing significant weight loss and therefore discontinue use. It costs around $100 a month (in 2022).
This is also called Orlistat and works to prevent the absorption of fat by the gastrointestinal tract. It does this by inhibiting an enzyme in the gut that allows fat to be digested and absorbed. It is taken as tablets with meals. It is a bit cheaper at approximately $90 a month but it has an unfortunate side effect of malodourous diarrhoea and therefore not well tolerated by patients (in 2022).
*this is by no means an exhaustive list of all medications available
A common question is to ask about the duration of these therapies. Unfortunately there is limited research into this topic and many studies only follow patients for a number of months, not years. We do know that a person’s hormones that lead to increased hunger tend to be long lasting in the body, upwards of six years and can be lifelong. This, and the risk of weight regain, needs to be taken into account when considering ceasing a therapy.
Weight loss medications are another tool in the battle against obesity. Best used in combination with other strategies, they can be helpful for weight loss but may prove even more useful in the weight maintenance phase. It is important to always enquire about efficacy, safety and cost before starting any such treatment.
Please contact us to meet with Dr Freeman and discuss all your options 🙂