10 - Medications: Are There Effective Weight Loss Drugs?

Hello, welcome to the "Scientific Weight Loss Course." I am Feng Xue.

In previous lectures, we discussed various aspects of lifestyle

adjustments in detail. Starting from this lecture, we enter the medical

intervention module to see if there are any medical methods that can

help us lose weight. In this lecture, let's first talk about weight

loss medications.

In daily life, many people feel that lifestyle adjustments take too

long to show results, so they get anxious and wonder if they can take a

shortcut. They hear that weight loss drugs don't require exercise or

dietary restrictions - just take them and the weight will drop rapidly,

so they want to try.

The question is: can weight loss medications actually help you lose

weight? Are they a shortcut to weight loss? In this lecture, we'll

discuss this issue.

When it comes to weight loss medications, what comes to mind? I think

it's nothing more than the following three categories:

The first category is various health supplements that claim to help

with weight loss, such as detox weight loss teas;

The second category is medications specifically developed for weight

loss needs;

The third category consists of medications not specifically developed

for weight loss but that have certain weight loss effects, such as

metformin, which has been very popular in recent years.

Let's discuss each category in detail.

First Category: Health Supplements Claiming Weight Loss Effects

First, let's talk about various health supplements that claim weight

loss effects, such as detox weight loss teas and slimming teas.

They either involve false advertising with no effect whatsoever; or

they secretly add laxatives to make you have diarrhea, which may work

short-term but damages your health; or they use the name "body shaping"

to add some fiber, probiotics, and other health ingredients, but these

things are actually dispensable for weight loss.

In summary, for these products, remember one sentence - from the

perspective of helping you lose weight healthily and effectively, they

are all fake.

Second Category: Specifically Marketed Weight Loss Medications

Since health supplements don't work, how effective are specialized

weight loss drugs?

Before answering this question, let me first show you the current state

of the weight loss drug market. Logically, weight loss is a rigid need

for many people, and there's a lack of controllable solutions, so the

weight loss drug market should be booming with companies making huge

profits. But what's the actual situation?

Currently, there are only 5-6 weight loss drugs globally. Among them,

the most potent and most anticipated, Qsymia, had disappointing

performance after launch, with annual sales of less than $100 million.

Compared to any single cardiovascular drug, this sales figure is much

smaller. Despite continuous promotions and price reductions,

prescription and shipment volumes continue to decline year by year.

The situation is similar for other weight loss drugs.

The reasons are certainly complex, but first, we must say that the

notorious history of weight loss drugs naturally makes it very

difficult for people to trust them.

Starting from 1890, over a hundred years ago, medical professionals

tried using sheep thyroid hormone as a weight loss drug. This resulted

in increased arrhythmias and deaths, and the drug was discontinued.

By 1950, it became popular to combine the antidepressant amphetamine

with diuretics as weight loss drugs. But this resulted in very serious

heart attacks and sudden deaths, so this drug also failed.

In 1996, the FDA (U.S. Food and Drug Administration) approved

dexfenfluramine as a weight loss drug. Unfortunately, due to serious

cardiovascular diseases it caused, the FDA had to announce the drug's

withdrawal from the market.

In 1997, both the United States and Canada approved sibutramine as a

weight loss drug. But soon, doctors discovered this drug could cause

strokes, arrhythmias, and uncontrollable hypertension, forcing them to

recall all sold medications.

At this point, the FDA's reputation was completely ruined. Faced with

such serious side effects, it had to raise the market approval

threshold for weight loss drugs to a more stringent level than other

medications. How are weight loss drugs doing today after the FDA

adjusted its standards?

Current weight loss drugs can be roughly divided into two categories -

One category increases energy consumption.

For example, the aforementioned Qsymia mimics sympathetic nervous

system excitement to increase human metabolism. People taking this drug

can lose 8.8kg within one year (75% of users) and 10% of body weight

(54% of users). Don't think this is too little - this is the most

potent weight loss drug to date. Even this effect comes with a series

of side effects including indigestion, constipation, dry mouth, and

insomnia.

What about the other category of weight loss drugs? They directly or

indirectly reduce energy absorption.

For example, orlistat works by binding to gastrointestinal lipases to

prevent fat absorption. Among all weight loss drugs, it has the

simplest weight loss logic and almost no potential safety issues, so

it's the only weight loss drug approved for market by China's drug

regulatory authority. In other words, in China, the only weight loss

drug you can buy is orlistat.

However, this reduction in fat absorption is not the "food passes

through without being absorbed" that many people imagine. In fact,

orlistat can only reduce fat absorption by 30%. This means that if you

eat too much, there's still excess energy remaining in the body, and

you'll still gain weight. Therefore, this drug must be combined with

dietary adjustments to be effective.

At the same time, since ingested fats cannot be completely absorbed and

must be expelled from the body, fatty diarrhea is inevitable, often

resulting in embarrassing accidents. Moreover, because fats cannot be

completely absorbed, some fat-soluble vitamins like vitamins A, D, E,

and K are very likely to be deficient, so these must be supplemented

when taking this drug.

With all these troubles, how effective is orlistat for weight loss?

Data shows: taking orlistat, within one year, 44% of people can lose 5%

of their weight, averaging only 2.6kg, far from being as miraculous as

advertised.

Actually, not just orlistat, the effects of currently most potent

weight loss drugs are far inferior to lifestyle management. Moreover,

side effects of weight loss drugs, such as nausea, diarrhea, dizziness,

dry mouth, palpitations, and arrhythmias, occur at rates close to 2%.

Don't think this is small - from our doctors' perspective, this

proportion is still quite high.

At this point, we discover: Behind the cold market reality is the

harsh truth that weight loss drugs have unsatisfactory effects and

significant side effects.

Precautions for Using Weight Loss Drugs

Due to weight loss drugs' historically poor track record, limited

effectiveness, and considerable side effects, we don't recommend them

for everyone but have specified clear target populations. Remember,

weight loss drugs are definitely a last resort after weighing pros and

cons.

Who can use weight loss drugs?

If your Body Mass Index (BMI) is greater than or equal to 27 and you

have at least one obesity-related disease, such as type 2 diabetes,

hypertension, or hyperlipidemia; or if you don't have any comorbid

diseases but your BMI is greater than or equal to 30, then after trying

ineffective lifestyle treatments, you can consider drug therapy.

Because at this point, the harm from obesity and its complications to

the body far exceeds the side effects of weight loss drugs.

But even when taking weight loss drugs, you must remember -

First, all drug-based weight loss, including orlistat, are long-term

treatment plans.

In plain terms, you need to take them long-term. If you want to use

drugs to quickly reach your ideal weight and then maintain it through

self-discipline, I advise you to give up early. All experiments show

that such short-term approaches don't work and almost always result in

rebound.

Second, while taking weight loss drugs, you must implement lifestyle

changes combining diet and exercise. Even after successful weight loss,

you must continue to persist.

Third Category: Drugs with Weight Loss Side Effects

Health supplements don't work, weight loss drugs aren't shortcuts - do

we have any other methods?

Yes, we do. In recent years, a "miracle drug" called metformin has

entered many people's sight.

Why is it called a miracle drug? Because metformin was originally just

a first-line drug for treating diabetes, but many studies in the past 5

years have found that besides treating diabetes, it can also help with

weight loss and seemingly prevent tumors and aging. Suddenly, it became

a highly sought-after drug, with many people starting to use it for

weight loss.

But as a doctor, I must advise you to stay calm.

Metformin's weight loss effect stems from a blood sugar reduction

study. At that time, researchers used metformin and another blood

sugar-lowering drug on two groups of diabetic patients respectively and

found that patients in the metformin group lost an average of 3.8kg.

Since then, metformin weight loss studies have gradually unfolded. But

unfortunately, most experiments haven't been able to reproduce such

obvious effects. Especially when metformin is used on non-diabetic

patients, its weight loss effect is even worse. Currently, the best

weight loss effect we can observe from metformin comes from a study

called diabetes prevention - over 2 years, the metformin group lost an

average of 2.1kg, averaging 1kg per year. You see, it's effective,

but the effect isn't obvious.

As for metformin's other miraculous effects, such as anti-aging,

preventing fatty liver, arthritis, and sleep apnea, they currently lack

more data support and are still in the research stage.

To summarize: metformin does have weight loss effects. For overweight

people with high blood sugar or diabetes, metformin is absolutely the

first choice. Because it can not only prevent high blood sugar from

developing into diabetes and lower blood sugar levels in diabetic

patients, but also has certain weight loss effects, making it indeed a

good choice.

But for a normal person, losing 2.1kg in 2 years - rather than taking

metformin three times a day, I think it's more cost-effective to get a

good night's sleep and eat two fewer bites at dinner.

Key Points

1. Medications are a last resort and should only be considered after

trying lifestyle treatments.

2. If BMI exceeds 27 with one obesity-related disease, or BMI exceeds

30, drug treatment can be considered after weighing pros and cons.

3. Weight loss drugs are a long-term solution - once you start, you

need to take them long-term.

4. While using weight loss drugs, you must also combine them with

lifestyle management.