As a dietitian who specializes in weight loss I’m not surprised when I get asked this question. We want a quick, easy solution if we can get it. Many people think
“If I wasn’t hungry all the time I could eat less and lose weight.”
Not so fast. Here’s what you need to know about appetite suppressants and weight loss.
These are available both over the counter and by prescription. There are a few that are FDA approved but most are not. The ones that require a prescription are FDA approved as well as one that is available over the counter (Alli or Orlistat.)
If the appetite suppressant has been approved by the FDA it has been tested for safety, efficacy and the claims have been verified. With no FDA approval, these things have not been tested or verified. For that reason, I do not recommend you consider one that is not FDA approved. At the end of this blog I’m going to list the ones with FDA approval so you can research them yourself if you so choose. I’m not going to discuss ones without FDA approval.
Just note that 5 appetite suppressants received FDA approval BUT over time there were so many reported side effects and complaints that the FDA removed their approval. These are:
So even with FDA approval, be cautious and make sure the risk is worth it.
When you take appetite suppressants, the medication stimulates areas of your brain that control satiety. The active ingredients interrupt hormonal responses, fooling your brain into thinking you feel full. As a result, it’s easier to eat less.
It works in two ways:
You don’t get hungry as often
You get full faster
Sounds great, huh? Not so fast. This is only going to help IF you overeat because you are physically hungry more than you need to be.
If you are triggered to eat due to stress or sadness, for example, and you take these pills, you’ll still feel stress or sadness and you’ll still be tempted to reach for food as a coping mechanism. Appetite has nothing to do with stress eating.
If you often eat just because you see food or smell food then your overeating has nothing to do with your appetite. These pills will not help.
Even if you think I’m not talking about you, I encourage you to do this first. Take at least 2 weeks and keep a food journal but not the kind of food journal you are thinking. Your emphasis is on WHY you eat, not WHAT you eat. Every time you go to eat or drink ask why. You may come up with things like:
There was just a few bites left
It was time to eat dinner
I was rewarding myself
I was trying to make myself feel better
I was nervous (social anxiety eating)
Everyone else was eating it
It was free so I had to take advantage of that
Pay attention to whether you are actually physically hungry. If feeling hungry all the time is not your problem, these pills aren’t your answer. Instead, you may lose weight just by paying close attention to cutting out times you eat when you aren’t even hungry.
Do they actually work??
They actually work pretty well with most people losing 5% of their body weight at the one year mark. However, they all say in combo with diet and exercise. So these don’t claim that you can continue eating the fried chicken and mashed potatoes but pop a pill and lose weight.
Do they have side effects?
Yes. Side effects depend on the drug. Sometimes they are not contraindicated meaning if you have a certain medical condition, such as liver disease, you should not take them. Also, consult Drugs.com and cross reference drug/drug interactions. These may interact with one of your current medications. Discuss with the doctor that provides you with the prescription.
The last thing you want to consider is what will happen when you stop taking them? You will have to keep eating less food or you will gain the weight back. It makes sense that they recommend diet and lifestyle change in addition to the pills and not in place of.
Do I ever recommend these?
In the ten years I have been counseling clients, I have to say that I have never recommended these. You have to change your lifestyle. You have to become a person who deals with stress in ways that don’t involve eating. You have to become a person that rarely eats desserts or drinks soda. You have to become a person who is active and works out. You have to learn your hunger and fullness cues and eat within those parameters. All that is hard work but it can be done without pills.
If you are interested, here’s a link on
How to pick a diet for weight loss – 3 tips
Below is a list of appetite suppressants currently available by prescription except for one over the counter (Orlistat). This information is not intended to prescribe. Consult your medical doctor first before taking any weight loss drug.
A final note, Semaglutide may be approved by the FDA in June 2021. For now it is not included in this list.
Orlistat (Xenical, Alli): works by blocking the enzyme that breaks down fat in the body. If you eat something that is high in fat, like a hot dog, the fat cannot be broken down and it will be excreted from the body. This can cause sudden, loose stools which some report as intolerable. If you know you are want to eat a high fat meal, you have the option of not taking the pill and therefore you don’t suffer the consequences. The way you lose weight is to take the pills, eat less fat which results in less overall calories.
Phentermine (Pro-Fast®): This drug decreases your appetite and is only approved for short-term use, up to 12 weeks. It is a stimulant and considered a “scheduled” drug by the Drug Enforcement Administration (DEA); this means that there is some potential for abuse.
Phentermine/topiramate (brand name Qsymia): This is a combination of phentermine and the anti-seizure drug, topiramate; using both drugs together works better than either drug alone to reduce appetite. Because of the potential for abuse, it is considered a scheduled drug by the DEA.
Naltrexone/bupropion (brand name Contrave): Naltrexone is used to treat drug and alcohol dependence. Bupropion is used to treat depression and help people quit smoking. The combination helps you to feel less hungry and to promote a feeling of fullness after eating smaller amounts of food.
Liraglutide (brand name Saxenda): This injectable drug is part of a class of drugs called GLP-1 agonists, most commonly used to treat type 2 diabetes. It makes you feel less hungry or full sooner so you can eat less.
Phendimetrazine (brand name Prelu-2®): This pill is short term and is used for obese patients who have not been able to lose weight with diet and exercise. It is considered an appetite suppressant.
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