Obesity is a chronic medical condition related to excess body fat. It can increase your risk of serious health problems, including diabetes, heart disease, stroke, and certain types of cancers. In South Africa, approximately 28% of adults are considered obese, which is higher than the average obesity rate in the African region. Obesity is usually measured using the Body Mass Index (BMI), which is calculated using weight vs. height. Anyone with a BMI of 25 or greater is considered overweight, while a BMI greater than 30 is considered obese. This measurement may not always be an accurate way to measure body fat, as it may be falsely high in people with a high muscle mass (since muscle weighs more than fat). Waist size is also used to measure obesity. Sometimes, diet and exercise alone are not effective to lower BMI enough to lower the risk of serious health complications. Weight loss surgery is one option, but there are several available medication therapies that may aid in weight loss. Medications for the treatment of obesity are recommended in most patients with a BMI greater than 30, and in patients with a BMI greater than 27 who have other risk factors for health complications such as diabetes and high blood pressure.
Orlistat -works in the GI tract to prevent the absorption of fat from the food you eat. Eating a diet that is very high in fat can cause unpleasant side effects, including oily faecal leakage, so it is recommended that patients taking orlistat maintain a low-fat diet.
Phentermine -is a stimulant medication that also decreases appetite. Because it can be potentially addictive, it is only recommended for short-term use.
Diethylpropion -is a stimulant medication that decreases appetite, and like phentermine, it can be addictive. It isn’t used often.
Bupropion/Naltrexone -is a combination pill containing a medication used to treat depression and a medication used to treat substance use disorder. It works as an appetite suppressant and controls cravings/addictive behaviours related to food.
Semaglutide -is a weekly injection that imitates a hormone in the body called GLP-1 (glucagon-like peptide-1), which acts in the brain to control appetite and make you feel full. It is also used in the treatment of type-2 diabetes.
Tirzepatide -is a weekly injection that acts in the same way as semaglutide that is approved for diabetes treatment. It also helps with weight loss and is expected to be approved for use in obesity treatment.
Herbals and supplements that claim to aid in weight loss are widely available. Active ingredients in these may include green tea extract, guarana, apple cider vinegar, garcinia cambogia, and others. It is important to know that although many of these medications claim to be safe and “all-natural,” many of these ingredients can cause dangerous side effects and drug interactions, and their possible benefits have not been clinically proven.
Side effects are possible with these medications. The most common ones are listed below.
-Diarrhoea -Headache -Dry mouth
-Constipation -Tiredness -Nausea/vomiting
-Dizziness -Restlessness -Increased heart rate and blood pressure
Rare, but serious side effects include a slight risk of pancreatitis, liver damage, and some kinds of cancers. It is important to give your doctor a full medical and family history before these medications are prescribed and to follow up with regular visits to monitor therapy. These medications are not appropriate for everyone, even with a BMI that indicates therapy may be needed, depending on other health conditions.
All these obesity treatment medications are intended to be used in addition to, not as a substitute for diet and exercise, for the best results.