1. Phentermine. This has been on the market and is still the best. According to some studies, a 5 pound weight loss (vs placebo) can be expected in 1 year. I usually see a minimum of 30 pounds. Phentermine is cheap and safe. It should be used with caution id you have high blood pressure or heart disease. Some studies claim addictive properties, but I have never had any patient become addicted to this—-ever!
2. Phentermine + Topamax. This is a great combination since it not only suppresses appetite but also curbs carbohydrate craving. Studies show an average of 19 pounds weight loss, but I also see greater than 30 pounds in most of my patients. This is very well tolerated but Topamax can cause memory loss at higher doses and should not be used if you have glaucoma. In addition all women of child bearing ages need to do a monthly pregnancy test since it is devastating to the fetus. The brand, QYSMIA is not better than the generic components and can cost $200/month vs $15 or less/month with the generics.
3. CONTRAVE is a combination of an antidepressant (Wellbutrin) and a narcotic antagonist (Naltrexone). I have seen mixed results and most of my patients are disappointed. The costs without a coupon is $200/month and obviously cannot be used with narcotics (will eliminate analgesic benefits of opioids). According to studies, one can expect to lose 9 pounds in 1 year.
4. BELVIQ is similar to antidepressants and therefore should not be combines with them. Studies show an average of 8 pounds lost in the first year. It is hard for me to comment on this because most of my patients don’t like the way it makes them feel. It is also very expensive ($200/month without a coupon)
5. ORLISTAT has been around for years, first as a prescription and currently over the counter. The average weight loss is claimed to be around 7 pounds. WARNING-fecal leakage is VERY common if you eat any fatty foods. I never recommend this.
6. SAXENDA is the newest to be approved. It is actually a diabetes medication which delays gastric emptying which makes you feel full. The most common side effect is nausea. No, this will not cause low sugars, even though it is marketed as VICTOZA for diabetics. The recommended dose is almost twice as high as that recommended for diabetes and I think the nausea will really limit its usefulness. I’m also sure insurance will not cover this unless you use VICTOZA off label-but then you’ll probably get labeled as a diabetic. Average weight loss expected is 12 pounds.
To sum things up, I would try phentermine, with or without Topamax and combine this with healthy lifestyle changes. Once weight loss goals have been achieved, I would continue Topamax indefinitely since 97% of dieters WILL gain ALL of their weight back.
Beware of over the counter supplements: Not only do they not work well but may be dangerous and contain MERIDIA, a terrible weight loss medicine from 20 years ago that was taken off of the market due to heart disease. Yes, some people have found success with HCG but this IS NOT SAFE and should be avoided.