What is Obesity Treatment?

Physician-supervised Options

Physician-supervised weight-loss programs are one-on-one treatment options that take place in a medical office. These programs are led by a healthcare provider (HCP) such as a:

  • Medical provider (MD, DO, PA, NP)
  • Registered dietitian (RD)
  • Health psychologist

Many times, several HCPs are involved and work as a team in these programs, as they include not only medical advice but also nutrition and lifestyle counseling.

The costs of these programs vary depending on the services offered. Your health insurance company might cover all or some of this treatment. If you have additional obesity-related health conditions such as high blood pressure or type 2 diabetes, they might affect your coverage for these treatment options. Make sure you read and understand your insurance coverage.

For long-term weight management, having a healthcare team that you feel comfortable with and who is trained in obesity medicine is crucial. If you do not currently have a physician who meets your needs, you should explore working with another physician. For help finding physicians and other healthcare providers in your area who are trained in obesity medicine, visit the OAC’s Obesity Care Provider Locator at ObesityCareProviders.com.

Your first consultation with a healthcare provider may include:

  • A detailed medical evaluation for obesity-related conditions
  • A look into your daily lifestyle
  • A physical exam
  • A weight history (including past weight-loss attempts)
  • A psychological history

Many patients come to the clinic with undiagnosed type 2 diabetes, high cholesterol, thyroid disorders, or sleep apnea. Your HCP may recommend additional tests based on your medical history and your initial physical exam. To help manage any obesity-related conditions as well as weight loss, your program may include:

  • Pre-packaged meal replacement plans
  • Medical weight management
Pre-Packaged Meal Replacement Plans

Pre-packaged meal replacement plans are a medically supervised weight-loss program. They use meal replacement options along with lifestyle modifications and behavior change counseling to help people reach and maintain their weight loss and health goals. These programs work as a transition to a healthier, self-prepared nutrition plan while offering education and support. Examples of these programs include:

    • Health Management Resources™(HMR)
    • Advanced Health System™(AHS)
    • New Direction™(Robard Corporation)
    • Medi-Fast™

How Does It Work? Individuals who are interested in starting a supervised weight-loss program must do so through an HCP. Most programs list participating providers on their websites.

A medically supervised weight-loss program has individualized phases. The phases generally begin with meal replacements and transition to the use of self-prepared foods for long-term weight loss. These programs also include guidance from a team of HCPs, access to group or individual counseling, and other support options. Each program will vary and it is important to discuss them with your HCP to find the best option for you.

Weight-loss: Individual results will vary, but patients may lose as much as 50 pounds or more over 18 to 24 weeks.

Concerns: As with any meal replacement program, there are concerns about the ability of participants to successfully readjust to eating healthy, self-prepared foods following the meal replacement phase. Additionally, insurance coverage varies, so interested individuals need to review their health insurance policy and contact their health insurance company if they have questions or concerns about their coverage.

Medical Weight Management

Who is a Candidate for Medications That Help Treat Obesity?

Many people have found that lifestyle changes, combined with medications that aid in weight loss, have been very effective for long-term weight management.

The FDA has approved six prescription medications for use in people with a BMI over 30 or a BMI over 27 when a patient has additional obesity-related conditions. They are available by prescription only, and you will need to discuss them with your HCP.

Chronic Weight Management Medications

  • Phentermine Products Adipex®, Lomaira®, or Suprenza® – Approved for short-term use
  • Orlistat, Xenical®, or Alli® – Approved for long-term use
  • Naltrexone HCI and Bupropion HCI CONTRAVE® – Approved for long-term use
  • Phentermine – Topiramate ER Osymia® – Approved for long-term use
  • Liraglutide Injection Saxxenda® – Approved for long-term use
  • Semaglutide Injection Wegovy® – Approved for long-term use
  • Setmelanotide Injection IMCIVREE® (for specific rare genetic diseases of obesity in children) – Approved for long-term use

The average weight loss resulting from prescription weight-loss drugs is 5-10% of your starting weight. It is important to know that everyone responds differently to medications. Most people who take the medication will see average results, while others may see more significant weight loss or none at all.

Will My Insurance Cover Medications to Treat Obesity?

Insurance coverage of prescription weight-loss medications varies by state and by insurance provider. You can log into your insurance provider’s website and look under the pharmacy benefits page to see if your insurance plan covers the medication you are considering.

A Closer Look at Medical Weight-loss Medications:

Adipex®, Lomaira®, and Suprenza® (Phentermine)

How does it work? Phentermine is a weight-loss medication that is available by prescription only and has been FDA-approved since 1959. It works on chemicals in your brain to decrease your appetite and includes a mild stimulant to give you energy. Phentermine is a pill taken once a day in the morning and is intended for short-term use.

Weight-loss: The average weight loss is 4-5% of your initial body weight after one year. For a person weighing 200 pounds, this is approximately a 10-pound weight loss.

Concerns: Because Phentermine is a stimulant, it may increase your blood pressure and heart rate, so you should be monitored by an HCP who is experienced in prescribing it. Patients with some heart conditions (such as uncontrolled blood pressure), glaucoma, stroke, or an overactive thyroid should avoid this medication.

Xenical® and Alli® (Orlistat)

How does it work? Orlistat is available over-the-counter as alli® and is also available in a higher dose prescription called Xenical®. Both are FDA-approved for weight loss and work by decreasing the amount of fat your body absorbs. It is taken three times per day before meals that contain dietary fat. Orlistat only allows your body to absorb two-thirds of the calories from the fat consumed in your meal. The other one-third is carried away through digestion and becomes part of your stool. More information can be found at MyAlli.com.

Weight loss: The average weight loss is 5% of your initial body weight. For a person weighing 200 pounds, this is approximately a 10-pound weight loss.

Concerns: For individuals who are already consuming a low-fat diet, this medication may not be effective as their calorie intake from fat is already low. People taking Orlistat should take a multivitamin as they are at an increased risk for vitamin deficiencies. Side effects are limited but can include cramps, gas, stool leakage, oil spotting, and gas with discharge. These symptoms will improve with a lower-fat diet.

Naltrexone HCI/Bupropion HCI (Contrave®)

How does it work? Contrave® was approved by the FDA in 2014 and is a combination of two medications approved for other medical conditions, Naltrexone and Bupropion. Naltrexone is a medication previously approved for the treatment of narcotic and alcohol dependency. Bupropion is a medication approved as an anti-depressant and to help people stop smoking. When used together, these medications decrease your appetite and help you control eating.

Weight-loss: Among individuals who took Contrave® for one year, 65% lost at least 5% of their initial body weight (10-pound weight-loss for a person who weighs 200 pounds), and 39% lost at least 10% of their body weight (20-pound weight-loss for a person who weighs 200 pounds).

Concerns: The most common side effects of Contrave® are nausea, constipation, headache, dry mouth, vomiting, and dizziness. This medication also has a small occurrence (6%) of increased blood pressure and heart rate.

Over-the-Counter Drugs

Currently, Alli® is the only over-the-counter (OTC) drug approved by the Food and Drug Administration (FDA) for weight loss. A drug that has FDA approval means the FDA has reviewed the product and found it to be safe and effective when used as directed. It is not recommended for children under 18 years of age or adults with a BMI below 25. It is important to talk with your HCP before taking any new medication.

How does it work? Alli® is a lower-dose version of the prescription drug Xenical® (Orlistat). It is a capsule taken three times each day before a meal that includes dietary fat. Alli® works by decreasing the amount of dietary fat absorbed in the intestines. When you take it with a meal, about 25% of the fat you eat isn’t broken down. The fat, calories, and nutrients not absorbed are then passed through as bowel movements.

Alli® is designed to help increase the amount of weight you lose while eating a healthy diet, exercising regularly, and drinking plenty of water. The company that manufactures this drug (GlaxoSmithKline group of companies) offers a website with educational and support resources for people taking Alli® at MyAlli.com.

Weight loss: The average weight loss for people who take Alli® is about five to ten pounds over six months. This medication is designed to increase your weight loss while you focus on living a healthy lifestyle. For example, if you’ve already lost five pounds by adopting a healthy diet and exercising, supplementing with alli® might boost your weight loss by two to three more pounds, resulting in a total weight loss of seven to eight pounds.

Concerns: Individuals taking Alli®must eat a healthy, balanced diet that includes some dietary fat. Alli® will not help much with weight loss if you are already following a strict low-fat and low-calorie diet. Individuals using Alli® on a regular basis should also take a multivitamin to avoid potential vitamin and mineral deficiencies, as not all nutrients you consume may be absorbed. The side effects of alli® are limited to the gastrointestinal (GI) system and commonly include gas, cramps, stool leakage, oily spotting, and gas with discharge. These side effects will decrease as you decrease the amount of fat you consume in your diet.

Phentermine-Topiramate ER (Osymia®)

How does it work? This combination of medications was approved by the FDA in 2012. Osymia® is a weight-loss drug that received FDA approval in 1959. Osymia® is traditionally used to prevent migraines and seizures. Together, they decrease your appetite and increase feelings of fullness after eating.

Weight-loss: Weight loss can vary by dosage. At the lower dose, 62% of individuals on Osymia® lost 5% of their starting weight. This is approximately a 10-pound weight loss for a person who weighs 200 pounds. Among people taking the higher dose, 48% lost 10% of their starting weight. This is approximately a 20-pound weight loss for a person who weighs 200 pounds.

Concerns: The most common side effects are dry mouth, constipation, and pins-and-needles feelings in the face, arms, hands, and feet. Insomnia may occur if taken later in the day. Women who are pregnant or who are considering becoming pregnant should not take Osymia® as it has been known to cause birth defects.

Liraglutide Injection (Saxxenda®)

How does it work? Saxxenda® is an injectable medication approved by the FDA in 2014 to treat type 2 diabetes. It works by increasing your body’s natural production of insulin, which regulates blood sugar levels. It also decreases the production of a hormone that opposes insulin, slows down the emptying of the stomach, and helps regulate fullness.

Weight-loss: In a study of individuals who were on Saxxenda® for one year, 73% lost at least 5% of their starting body weight (10-pound weight-loss for a person who weighs 200 pounds), and 41% lost at least 10% of their initial body weight (20-pound weight-loss for a person who weighs 200 pounds).

Concerns: The most common side effects are nausea, vomiting, diarrhea, and constipation.

Semaglutide Injection (Wegovy®)

How does it work? Wegovy® is an injectable prescription medicine used for adults with obesity or excess weight who also have weight-related medical problems to help them lose weight. Wegovy® is a glucagon-like-peptide-1 (GLP-1) receptor agonist that is engineered in the laboratory. What this means is that Wegovy® mimics the naturally occurring GLP-1 hormone that is released by our intestines into our bloodstream within minutes after we ingest food.

Weight-loss: The effectiveness and safety of Wegovy® have both been demonstrated in the Semaglutide Treatment Effect for People with Obesity (STEP) program. The four STEP studies involved 4,500 individuals from around the world who were either affected by obesity or classified as overweight with co-existing medical conditions resulting from their excess weight.

All individuals were provided lifestyle counseling and were randomized at the flip of a coin to receive either Wegovy® or a marching placebo (a substance that has no therapeutic effect) for a total of 68 weeks.

The average weight loss in the Wegovy®  STEP studies was 15 to 17% of the individual’s starting weight. For an individual weighing 230 pounds, this is a 35 to 39-pound weight loss. In the STEP 1 study, one-third of individuals were able to lose at least 20% of their total body weight.

Concerns: Wegovy® should not be used in patients with a history of severe allergic reactions to Semaglutide, nor should it be used in patients with a personal or family history of medullary thyroid carcinoma or a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Common side effects include nausea, diarrhea, vomiting, and constipation. Wegovy® may also cause hypoglycemia (low blood sugar) if you take it with some other diabetes medications such as sulfonylureas and insulin. Wegovy® also has warnings for inflammation of the pancreas, gallbladder problems, increased heart rate, acute kidney injury (from dehydration), and diabetic retinopathy (damage to the eye’s retina if you have diabetes).