Weight loss meds: friend or foe?

Let's face it: it can be pretty defeating when the bathroom scale's dial doesn't move any further to the left when you're trying so hard.

Even those on the most stringent exercise and diet routines get into a slump from time to time.

We're sure people participating in The News Journal's annual health challenge "Take It Off," sponsored by Christiana Care Health System, are focused on dropping to a healthier weight, but experts say that can be difficult even when you stick to diet and exercise programs.

Which is why so many people are asking themselves whether they need any extra help, and whether that help could come in the form of a pill.

Maybe, under certain circumstances, is the answer.

Prescription drugs for weight loss are not tailored to people who want to lose a few stubborn pounds. Generally people who consider the pills have not been able to lose weight from changing what they eat and exercising and have a body mass index over 30 and have an obesity-related medical problem such as high blood pressure or diabetes.

They have side effects that include diarrhea, increased heart rate, insomnia, increased blood pressure and nausea.

Weight loss pills can be beneficial, said Crystal Bouchard a dietitian with Bayhealth Medical Center, but as long as a healthy diet and exercise are in the picture, too.

"They can't be two separate entities," Bouchard said.

Most importantly: weight loss medication must be supervised by a doctor. Common prescription obesity drugs include Belviq, Adipex-P(Phentermine) and Contrave, which decrease appetite and increase the feeling of fullness, and Saxenda, which increases the feeling of fullness by slowing the emptying process of the stomach.

"Each one works differently," says Dr. Anita P. Raghuwanshi, a physician from Beebe Healthcare specializing in endocrinology, diabetes and metabolism.

Phentermine, she explained, is a stimulant which helps people lose weight at first, but not long-term. It also can increase heart rate and blood pressure as a stress response would, so it is not recommended for anyone with a heart condition.

Saxenda is a weight loss injectable drug that at a lower dose is a diabetes medication called Victoza.

"It's a much higher dose for the appetite-blocking effect," she said, noting that a dose of Saxenda is 3 milligrams while a dose of Victoza is only 1.8.

In order to figure out whether a pill will work and whether it's right, people meed to be honest about why they are overeating and gaining weight.

"A lot of people wind up going from one (medication) to another to another to see what works for them. A lot of people don’t know why they overeat. They just overeat," Raghuwanshi added.

There's a catch with all FDA approved weight loss medications.

"Insurance almost never covers the costs," said Dr. James Lenhard, medical director of Christiana Care Health System’s Diabetes and Metabolic Diseases Center and Christiana Care’s Weight Management Center.

And they are not magic bullets. You can't bank on the drugs working by themselves.

"The amount of weight that weight loss medications provide is generally less than people want it to be," explained Lenhard.

On average people lose about two pounds with zero lifestyle changes, he added.

A study dating back to 2014 that looked at 21 prescription weight loss drug trials found that people need to make diet and exercise changes in addition to medication to significantly drop pounds and improve their risk of developing chronic disease. They categorized significant or meaningful weight loss as losing about 5 percent of body weight, which begins to lower a person's risk of cardiovascular disease and diabetes, among other diseases.

Before considering medication to help you through a weight loss slump, Bouchard suggests looking at your diet and exercise.

Change your workout routine by increasing your resistance on a treadmill or elliptical or try a completely different fitness class. Use a food journal to mark down what you are eating and when, she added. For instance you may be eating healthy, portioned meals, but snacking way too often during the day.

"You can really see what extra bits and pieces are in there," Bouchard said. "See where you can pull back."

The ideal diet is one that keeps you full with low-density foods like fruits and vegetables, Raghuwanshi said, and regular exercise is beneficial. However, she is not against prescribing a weight loss medication to help jump start their goals.

"Diet and exercise by themselves very often fail. You don’t want people to give up on diet and exercise simply because they are not losing pounds," she said. "I want their diet and exercise to be successful."

Weight loss supplements that can be bought over-the-counter, on the other hand, are not approved by the U.S. Food and Drug Administration. Under the Federal Food, Drug and Cosmetics Act dietary supplement manufacturers do not need prove that their products are safe. An alert by the FDA states "it is the company’s responsibility to make sure its products are safe and that any claims made about such products are true."

It's appealing to go for less expensive, non approved weight loss supplements, but the chance that they will work and are safe is a crap-shoot.

"There's always a snake oil salesman willing to sell them something," said Lenhard said. Some extremely off-label pills may even have ibuprofen or lead mixed in. "There is a lot of fly by night stuff out there."

Supplements do not go through clinical trials to test efficiency, Bouchard added.

"It's very skewed information. It's frustrating really...Marketing is so powerful," she said. "I think before you spend any money you've got to consult a dietitian or doctor to get on a healthy lifestyle."

Jen Rini can be reached at (302)324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.