Weight Matters: When Willpower Isn't Enough

By Jacob, Bonnie

When you're significantly overweight, nobody has to tell you that you'd probably be happier and healthier without the extra pounds. But what if the weight won't come off, no matter how hard you try?

Willpower alone might not be enough for people who are significantly overweight. If you've honestly tried to lose weight and failed, medications or surgery could be helpful under certain conditions.

Most medical weight-loss programs first try to help you make the long-term behavioral changes necessary to achieve and maintain a healthy weight. This includes exercising regularly and eating healthy food.

If you still remain seriously overweight, you and your health care provider might discuss these other options.


Prescription medications can be helpful, but they're not for everyone. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), drugs are generally recommended only if you have a body mass index (BMI) of 30 or higher, or if your BMI is 27 or more and you have conditions caused or made worse by obesity, such as high blood pressure; dyslipidemia, which means abnormal amounts of fat in the blood; or type 2 diabetes. (A BMI of 18.5 to 24.9 is considered healthy.)

People with certain chronic health conditions or who are taking certain medications may not be able to take weight-loss medications. Be sure your health care provider knows if you have any of these conditions: high blood pressure, hyperthyroidism, anorexia, bulimia, depression, migraine headaches, glaucoma, diabetes or heart disease, or you have abused drugs or alcohol. Medications to help weight loss must be used in combination with regular physical activity and a healthy eating program.

Weight-loss drugs can help a person lose five to 22 pounds more than he or she could using non-drug treatments. The greatest amount of weight loss usually occurs within the first six months after starting a medication. After six months, weight tends to level off or increase. Maintaining weight after stopping weight-loss medications can be difficult.

These are the types of medications available for weight loss:

Appetite suppressants

These drugs decrease appetite or increase the feeling of being full, the NIDDK says. They do this by increasing one or more chemicals in the brain that affect mood and appetite. Phentermine (Fastin, Adipex-P, Pro-Fast and other brand names) and sibutramine (Meridia) are the most commonly prescribed appetite-suppressants. Other appetite suppressants are diethylpropion (Tenuate) and phendimetrazine (Bontril, Plegine and other brand names).

Side effects of phentermine, phendimetrazine, and diethylpropion can include sleeplessness, nervousness and euphoria. These drugs may aggravate existing heart disease, high blood pressure, an overactive thyroid gland or glaucoma. People with these conditions should not take these medications.

Sibutramine can be used for up to two years. Side effects of sibutramine include an increase in blood pressure and heart rate. These are usually small increases, but people with high blood pressure, heart disease, irregular heartbeat or history of stroke should not take sibutramine. All people taking it should have their blood pressure checked regularly.

(Amphetamines also suppress appetite, but because of the potential for abuse and dependence, they are NOT recommended as weight-loss drugs.)

Lipase inhibitors

There is only one drug in this class approved by the U.S. Food and Drug Administration: orlistat (Xenical). It is approved for teens ages 12 and older. (All other weight-loss drugs are approved for teens older than 16 and adults). Orlistat works by decreasing the body’s ability to absorb some fat from food, the NIDDK says. If less fat is absorbed, there are fewer calories for the body to use or store. Side effects of orlistat are usually mild and temporary. They include cramping, intestinal discomfort, gas, diarrhea and leakage of oily stool. Eating foods that are high in fat can make the side effects worse. Orlistat reduces the absorption of fat-soluble vitamins, so your doctor may advise taking a multivitamin at least two hours before or after taking orlistat.

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