Have you beaten yourself up trying to diet your way to sustainable weight loss? You’re not alone. It can be hard to know which of the hundreds of diets and retail weight loss plans to try. Then there’s the disappointment and frustration when nothing seems to work.

One thing that’s often missing from many commercial programs is personalized support from health care experts – something that’s part of a medically supervised weight management program. And because your brain can get comfortable with your current weight and resist change, it may be that prescription weight loss medications could help.

Read on to learn about medical weight management programs and prescription weight loss pills that might help.

Medical weight management is a program to help people lose weight and maintain that weight loss without surgery. This means that medical weight management programs have a big focus on helping you build daily habits for maintaining a healthy lifestyle. Your doctor may also recommend prescription weight loss medication.

Medical weight management is different than dieting on your own because you have a team of experts to offer guidance and support, and to hold you accountable. You’ll have regular check-ins to celebrate your successes and talk about your challenges.

Your team will include both a doctor and a dietitian. Depending on your needs, you may also work with nurses, physical therapists and psychologists. This team will identify the best treatment plan based on your unique attitudes, habits, environment and physiology (how your body works).

Medical weight management can be a first step or ongoing

Good candidates for medical weight management are those who’ve tried lifestyle changes but struggle to maintain them. To be considered for medical weight management, you need to have a BMI (body mass index) of at least 35.

Your BMI is a measurement of your body fat based on your height and weight. You may know your BMI already, but if you don’t, you can use this BMI calculator to figure it out.

Medical weight management may make sense for you if one of the following describes you:

  1. Losing 7-20% of your body weight would help you reach a comfortable weight.
  2. You have a BMI over 40 and your health insurance plan requires a medical weight loss attempt before surgery, or if surgery isn’t covered by your plan.
  3. You can’t have bariatric surgery because of a medical or psychological condition that would make surgery harmful.
  4. You’re interested in using a medication for weight loss and have checked with your insurance provider to see which weight loss medications are covered by your plan.

How much you lose with medical weight loss depends on your body

Weight loss is highly variable, as everyone’s body responds differently to treatments. Your doctor can help give you an estimate for how much weight you can expect to lose.

There are other options like bariatric surgery if you’re unable to meet your weight loss goals through a medical weight management program.

Medical weight management takes time

Everybody is different, so it’s hard to know how quickly the weight will come off. Some people will start dropping pounds right away. But for others, it can take a little longer.

It’s important to remember that medical weight management isn’t a speed run. The goal isn’t losing weight as fast as possible, but creating sustainable changes that will help you manage your weight over the long-term.

That doesn’t mean you’ll be in a medical weight management program forever. Once you’re able to keep the weight off for 3-6 months, you should be able to work with a primary care doctor for ongoing weight control.

How medical weight loss programs work

If you have uncontrolled hunger, cravings and “brain chatter” about food, a medical weight management program can help you identify and change habits so you can lose weight.

Medical weight management programs work by addressing the behaviors, habits and attitudes that are getting in the way between you and a healthy weight.

Identifying the best diet for sustainable weight loss

Food choices are a common cause of unintended weight gain – and can get in the way of weight loss too.

A weight loss diet typically includes less refined carbs and more fiber-rich food and lean meats. That’s because foods that are lower in fat and higher in fiber tend to have fewer calories and fill you up more. But it’s not always easy to figure out how to improve your diet and then stick with the changes you make.

It’s important to remember that no food is “bad” or completely off-limits. The goal is to fill up your plate (and stomach) with a balanced diet that doesn’t have more calories than your body needs.

One of the benefits of a medical weight management program is ongoing support from a dietitian, who can help you understand how food choices support your goals for losing or maintaining body weight.

Creating an exercise plan you can live (and lose weight) with

It could be that you don’t know where to start with an exercise program. Or maybe you exercise regularly and find that you’re not able to drop pounds (or that you keep gaining weight).

As part of a medical weight management program, you’ll learn about the exercises that will help you achieve and maintain a healthy body weight. Because here’s the thing: not all exercise is created equal when it comes to managing your body weight.

Most people will benefit from a combination of cardio, strength training and flexibility exercises. If you have physical limitations that are getting in the way of exercise, a physical therapist will help you ease into an exercise program.

Using mental health support to address your relationship with food

Food is fuel – but it’s more than that. Eating is at the center of social activities. And for many people, food is comfort when they’re sad, stressed or tired.

Food can also be a source of frustration. It may seem like you can’t lose weight no matter what you eat and what you do. Even if you lose weight, the pounds can return – the process can go on and on. This yo-yo dieting can affect your relationship with food and has the potential to lead to an eating disorder like binge eating disorder.

To lose weight (and keep it off), it’s important to address your attitudes and emotions related to food. Experts at the weight loss center can help you understand what might be causing emotional eating and put together a treatment plan that will help you deal with stressors in the future.

Overcoming physiological reasons that are keeping you from losing weight

Weight control isn’t always as simple as balancing what you eat with what you do. It may be that your body’s processes are working against you.

Generally speaking, when you gain weight, it means you’re eating more calories than your body is burning. But this can happen even if you’re exercising regularly and eating a healthy diet. Your caloric needs may be different because of aging or certain behaviors. But dieting also changes how your body works and how many calories it needs.

Your brain gets used to your body being a certain weight and takes steps to keep you at that size. Losing weight can actually lower your metabolic rate, meaning that your body burns through food more slowly, so you need to eat less. And that’s not the only change. After losing weight it’s common to have an increased appetite – even though you need fewer calories to support your smaller body. Which means, you might regain the weight back or gain even more.

If there are physiological reasons why you can’t lose weight, there are medications that may be able to help.

What you should know about prescription weight loss medications

There are a lot of questions about weight loss medications. Like, what is the most effective weight loss prescription drug? What prescription drugs make you lose weight fast? There is a lot of information to consider.

Weight loss medications are most effective as part of a larger program

The first thing to know about prescription weight loss medications is that they work best as part of a larger medical weight management program that includes a balanced diet and regular exercise. Weight loss medications are not a miracle cure but may help people who aren’t able to lose weight with diet and exercise alone.

To try and find the best fit for you, your doctor will likely prescribe a limited amount of a medication, so you can try it for 4-6 weeks. Then they’ll meet with you to discuss your results. If things are working well, you’ll likely continue on that prescription. If the weight isn’t coming off or you have bothersome side effects, your doctor may recommend a different option.

It’s also important to note that if weight loss medications work for you, you’ll likely need to keep taking them if you want to keep the weight off.

Weight loss medications aren’t an option for everyone

Medications have different guidelines for use. These may relate to:

  • Your age – Many of the medications are just for adults but some are approved for use in children. There are also medications that may not be appropriate for people over 65 years old.
  • Your medical conditions – Depending on other medical conditions, you may not be able to take some weight loss medications. For example, some medications may not be appropriate if you have liver problems or are prone to seizures.
  • Your weight – Most weight loss medications are used for people with a BMI of at least 30, or 27 with a weight-related condition.

Weight loss medications work in different ways

Medications can lower your set-point body weight. This means the brain stops defending a higher weight and is comfortable at a lower weight. Instead of having hunger going up and metabolism going down, medicines can use hormonal changes to address the physiologic responses to weight loss. Medications usually work by doing one or more of the following:

  • Controlling hunger – Reduces your appetite by providing a feeling of fullness and reduced cravings for certain foods.
  • Reducing absorption – Makes it so your body is less able to process certain nutrients such as fat, so your body metabolizes fewer calories.
  • Increasing fat burning – Helps your body burn more calories.

Most people who try weight loss medications, lose weight

About 85% of people who try weight loss medications lose a significant amount of weight. But not everyone responds to medications in the same way or loses the same amount.

Typical weight loss with weight loss medications

Response How many people How much weight loss
Above average 15% of people 15-20% (or more) of body weight
Average 70% of people 7-15% of body weight
Non-response 15% of people Little or no weight loss

Not all weight loss drugs are safe

A common question is, are weight loss pills safe? The answer is that weight loss medications that are approved by the U.S. Food and Drug Administration (FDA) are generally considered safe and effective. When side effects happen, they are usually mild and include nausea, constipation and diarrhea. Serious side effects are rare.

Pills and supplements that aren’t approved by the FDA aren’t always safe. They also tend to be less effective than prescription medications (if they work at all).

How do you know if a weight loss medication is FDA approved? Most FDA-approved medications are only available by prescription. The only FDA-approved medication that’s available over the counter is orlistat, which we’ll talk about below.

FDA-approved weight loss drugs

There are different FDA-approved weight loss medications that may be recommended as part of a medical weight management program.

Phentermine-topiramate (Qsymia)

This weight loss pill stimulates your nervous system, reduces your appetite and makes you feel full. So, how much weight can you lose on phentermine? It varies by person, but research shows that people lose an average of 15-20 pounds in six months. The most common side effects include dry mouth, constipation and an uncomfortable tingling sensation.

Bupropion-naltrexone (Contrave)

This weight loss pill is a combination of two medications – it includes an antidepressant (bupropion) and a medication used for opioid and alcohol use disorder (naltrexone). A review of several studies shows you can lose up to 20 pounds with bupropion-naltrexone. There’s also research showing that this medication can help you keep the weight off. Side effects include nausea, constipation, headaches, vomiting, dizziness and insomnia.

Orlistat (Xenical, Alli)

Orlistat is a weight loss pill that makes it so your body can’t digest fat as efficiently. Instead, the fat comes out in your poop. As a result, you absorb fewer calories. But it causes a range of digestive side effects, including stomach pain and oily stools. People taking orlistat typically lose 5-10 pounds in six months.

GLP-1 agonists: Semaglutide (Wegovy), liraglutide (Saxenda) and tirzepatide (Mounjaro)

GLP-1 agonists are weight loss medications that cause your stomach to empty more slowly, so you feel full longer. They can also reduce the release of glucagon, a hormone that increases feelings of hunger. In a clinical study, the majority of people who took semaglutide were able to lose weight and keep it off for more than five years. Common side effects include nausea, diarrhea, vomiting, constipation, stomach pain, headache, tiredness, upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, runny nose and a sore throat.

Setmelanotide (Imcivree)

Setmelanotide is a weight loss injection for obesity caused by specific genetic mutations. The medicine works by helping to activate the melanocortin 4 receptors in the brain. This can lead to reduced hunger, eating fewer calories and a boosted metabolism. A study found that one-third of people had a 10% or more weight loss after a year. Common side effects of setmelanotide include injection site reactions, nausea, headache, diarrhea, hyperpigmentation, and pain in your stomach or back.

Are medical weight loss programs and weight loss drugs covered by insurance?

Some patients are able to get coverage for prescribed weight loss medications through their health insurance, but each plan is different. This can help offset some costs and make weight management more affordable. If you’re considering a medical weight loss program, the best first step is to contact your insurance plan provider to learn more about your coverage.

Reaching weight loss goals isn’t as simple as eating less and exercising more. We can help.

Weight loss is different for everyone because everyone’s body is different. At Park Nicollet’s Bariatric Surgery and Weight Center, we understand the struggle. We’ll work with you to improve your health by working toward a healthy body weight.