Setting Realistic Expectations for Drug-Assisted Weight Loss
With so many drug and over-the-counter options that claim easy weight loss these days, it is hard to pinpoint which therapies actually work, and which ones are bogus. What we know for a fact, however, is that weight loss is beneficial for people with type 2 diabetes. Numerous studies have demonstrated that weight loss improves glycemic control.1
When are weight loss drugs used for people with diabetes?
There are many drugs that are approved by the Food and Drug Administration (FDA) for weight loss. Pharmaceutical drugs can be an effective way to reduce weight for people with diabetes. However, pharmaceuticals are rarely trialed first-line, due to their high failure rates as a result of adverse effects.2 Overall, drugs are not recommended as the primary means of weight loss for people with diabetes. Candidates for drug therapy include:3
- People with a body mass index greater than 30, or someone with a BMI of 27-29.9 and has certain medial conditions
- Those who have not met a weight loss goal of a 5% reduction through lifestyle interventions over a 3-6 month period
Goals when using weight loss drugs
Before a doctor initiates drug therapy, it is important to outline the goals of treatment. It is also crucial to be realistic about expectations of weight loss, to minimize getting discouraged. The goals of therapy for each individual are unique depending on discussions with the doctor and the individual starting therapy, but may include any of the following.
Most clinical trials on these drugs show that an average of 4-8% weight loss over a 6-12 month period is achievable.2 That means that for a 200 pound person, they can expect to lose anywhere between 8-16 pounds from the medication alone. However, it is also important to understand that not all drugs work for each individual.
Maintaining target weight
We often hear that maintaining weight is much harder than weight loss itself. Inevitably, a goal of therapy will likely include weight maintenance. It is critical to understand that these drugs often result in a weight loss plateau when the maximum effect is reached; that is, people will not continue to lose 4-8% of their body weight every year. Most people don’t realize that when they stop the drug, all lost weight is typically gained back.
Using other outcome measures, such as A1C or blood pressure, can be more encouraging than focusing on pounds lost. Often, these health effects are more dramatic compared to weight loss. Many people have been able to reduce their diabetes medications' dose as a result of small weight losses of 5%.
Reducing side effects from drugs
Like all drugs, weight loss drugs also come with side effects. In addition, we don’t often have data on the long-term safety of these therapies. For example, Orlistat, a common weight-loss medication, has only clinical evidence of safety for 4 years. We don’t have any evidence for safety or use beyond these 4 years.3
It is important to set realistic expectations when starting a weight loss medication. Doing so will help maintain focus and minimize rebound weight gain if expectations are not met.
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