- Semaglutide (Wegovy)
- Treatment duration: 68 weeks
- Dose escalation:
• Weeks 1–4: 0.25 mg weekly SC
• Weeks 5–8: 0.5 mg weekly SC
• Incrementally up to 2.4 mg weekly SC - Average weight reduction: 14.9% of baseline weight【STEP1】
- Common side effects: nausea (40%), vomiting (20%), diarrhea, constipation, abdominal pain
- Tirzepatide (Zepbound)
- Treatment duration: 72 weeks
- Dose escalation:
• Weeks 1–4: 2.5 mg weekly SC
• Increase every 4 weeks to 5 mg, 10 mg, then 15 mg weekly SC - Average weight reduction: up to 20.9% at 15 mg dose【SURMOUNT-1】
- Common side effects: nausea (35%), diarrhea, decreased appetite, vomiting
- Liraglutide (Saxenda)
- Treatment duration: 56 weeks
- Dose escalation: 0.6 mg daily SC up to 3.0 mg daily SC
- Average weight reduction: ~8.0% of baseline weight【SCALE】
- Common side effects: nausea (40%), vomiting, diarrhea, constipation, injection-site reactions
- Orlistat (Xenical)
- Treatment duration: 12 months or longer
- Dose: 120 mg three times daily with each main meal
- Average weight reduction: 3–5% of baseline weight
- Common side effects: oily spotting, flatulence with discharge, fecal urgency
- Naltrexone–Bupropion (Contrave)
- Treatment duration: 56 weeks
- Dose escalation:
• Week 1: 8 mg/90 mg once daily
• Weeks 2–4: escalate to 8 mg/90 mg twice daily - Average weight reduction: ~4.8% of baseline weight
- Common side effects: nausea, headache, constipation, dizziness
- Phentermine–Topiramate (Qsymia)
- Treatment duration: 12 months minimum
- Dose escalation:
• 3.75 mg/23 mg once daily for 2 weeks
• Increase to 7.5 mg/46 mg daily; may escalate to 15 mg/92 mg daily - Average weight reduction: ~9.3% of baseline weight
- Common side effects: dry mouth, paresthesia, constipation, insomnia
How Should I Prepare?
- Continue a reduced-calorie, balanced diet and exercise program.
- Obtain baseline labs (glucose, liver/kidney function).
- Review all current medications for potential interactions.
- Discuss insurance coverage and financial assistance programs if needed.
What Can I Expect?
- Gradual weight loss over months; most drugs peak at 6–18 months.
- Regular monitoring of vital signs, weight, and side effects in monthly visits.
- Dose adjustments or therapy changes based on response and tolerability.
Risks & Possible Complications
- Gastrointestinal upset is the most common side effect and often diminishes over time.
- Rare but serious risks (pancreatitis, gallstones, mood changes) require prompt reporting.
- Birth defects risk—women of childbearing potential must use effective contraception.
Why Opt for Medication?
- Obesity is a chronic disease with strong genetic and hormonal drivers.
- Medications target physiological pathways beyond willpower—reducing hunger signals and improving satiety.
- Achieving ≥10% weight loss with drugs can reverse prediabetes, lower blood pressure, and reduce cardiovascular risk more reliably than lifestyle changes alone.
Follow-Up & Support
- Monthly visits for the first 6 months, then every 3 months.
- Ongoing nutritional counseling and behavioral therapy.
- Laboratory monitoring at 3 and 6 months, then annually.
