Q
: Who should consider weight loss medication and what are some options ?
A
: Suitable candidates for weight loss drugs are those who are overweight or obese , with a body mass index ( BMI ) of over 25 . However , various other options are also available to these patients , including non-invasive procedures and surgery . One of these is a new technique that uses an intragastric balloon that patients can swallow , enabling it to fill up a large space in the stomach .
Weight loss medications mostly comprise appetite suppressants that trick the stomach into thinking it ’ s full . Most of these can achieve weight loss equivalent to 5-6 percent of a patient ’ s body weight . In addition , a pancreatic enzyme lipase inhibitor that acts by diminishing the absorption of dietary fat has also proven effective .
But probably the best option that we have at the moment is a medication called liraglutide , which is more potent than the previous generation of drugs . This works by accentuating the hormone that would be released after you ’ ve eaten a heavy meal . It can lower total body weight by up to 10 percent .
Q
: How long do you have to take these drugs ?
A
: It depends . Most of them suppress your appetite but can take a week or two before you can see any effects , provided you can tolerate their side effects . And you have to continue taking them . Usually , when patients stop taking these drugs , they ’ ll gain back some , if not most , of their weight , especially if they ’ ve been unable to change their eating habits . That ’ s why , beyond the drugs and modalities we have for treating obesity at the moment , we try
to modify the way patients eat . It ’ s human nature to go back to your old habits . If someone is very disciplined , they will usually be able to keep the weight off .
Exercise is also very important . Most of the published data on these drugs has been done in combination with exercise . For most of the drugs available today , we need to prescribe drugs plus exercise in order to have the maximum effect .
Q
: What are the side effects ?
A
: All of the weight loss drugs we prescribe have been approved by the US Food and Drug Administration and regulators in Asian countries . Most of the older-generation drugs tend to cause a lot of headaches and constipation , while the newer ones cause some nausea and vomiting . They ’ re actually dose-dependent so the bigger the dose , the more severe the side effects . It just depends on how well the patients can tolerate them .
While all the other weight loss medications are taken orally , liraglutide is an injectable drug that can be administered at home with a bit of training . One drawback is that patients might not want to give themselves a daily injection , and it also needs to be refrigerated . Because it creates a sense of fullness , the patient might feel nauseated and want to vomit . The recommended treatment duration is around three months before we can see good effects .
Dr Lau Peng Choong
Dr Lau Peng Choong is a general surgeon with a subspeciality in gastrointestinal surgery at Pantai Hospital Kuala Lumpur .
10 NOVEMBER 2020 GlobalHealthAsiaPacific . com