Medicines to manage your weight (According to the NHS)

Weight management medications may be prescribed to support weight loss in adults when lifestyle changes, such as a healthy diet and increased exercise, are insufficient.

 The following medications are deemed safe and effective for weight management on the NHS based on clinical trials: - Orlistat - Liraglutide - Semaglutide - Tirzepatide

These medications should only be used under the guidance of a doctor or pharmacist, who will assess your health to ensure the medication is suitable, weighing its benefits against potential side effects. They must be combined with a reduced-calorie diet and regular physical activity.

Never use weight management medications without a prescription, as they may be unsafe and cause serious side effects.

Orlistat:

Orlistat reduces fat absorption by about one-third, passing unabsorbed fat through stool, which can prevent weight gain and aid weight loss. A balanced diet and regular exercise are required before, during, and after treatment. Orlistat is available by prescription or at a lower dose over-the-counter as Alli or Orlos, under pharmacist supervision.

When to Use Orlistat: Orlistat is typically prescribed if significant efforts to lose weight through lifestyle changes have been unsuccessful and you have: - A BMI of 28 or higher with weight-related conditions (e.g., high blood pressure, type 2 diabetes) - A BMI of 30 or higher It’s not recommended for pregnant or breastfeeding women.

Duration: Continue orlistat beyond 3 months only if you’ve lost 5% of your body weight. It begins affecting fat digestion within 1–2 days. If no weight loss occurs after 3 months, consult your doctor or pharmacist about stopping treatment.

Health Conditions: If you have conditions like type 2 diabetes, high blood pressure, or kidney disease, your medication doses may need adjustment. Speak to your doctor before starting orlistat. For those with type 2 diabetes, weight loss may be slower, and targets may be adjusted.

Side Effects: Common side effects include: - Fatty or oily stools - Urgent or frequent bowel movements - Oily rectal discharge - Flatulence These are less likely with a low-fat diet. If taking oral contraceptives and experiencing severe diarrhea, use additional contraception (e.g., condoms), as diarrhea may reduce the pill’s effectiveness.

Weight Management Injections: Liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Mounjaro) are injectable medications that reduce appetite and slow stomach emptying. They require a prescription from a specialist weight management service, alongside a reduced-calorie diet and exercise. Your doctor will discuss benefits, limitations, and side effects. If you’re eating less due to reduced appetite, you may need supplements to ensure adequate nutrient intake.

Liraglutide (Saxenda)

 Liraglutide is prescribed by a specialist weight management service if diet and exercise alone are ineffective.

When to Use Liraglutide:  Suitable for adults up to age 75 with: - A BMI of 35 or higher (or 32.5+ for Asian, Chinese, Middle Eastern, Black African, or African-Caribbean descent) - Non-diabetic hyperglycemia - High risk of cardiovascular issues (e.g., high blood pressure, high cholesterol) It’s not recommended for those with liver or kidney issues, or if pregnant or breastfeeding.

Duration: Continue liraglutide beyond 3 months only if you’ve lost 5% of your body weight. 

Semaglutide (Wegovy)

Usually taken weekly, semaglutide is prescribed by a specialist weight management service if diet and exercise are insufficient. 

When to Use Semaglutide:  Prescribed for those with weight-related health issues and: - A BMI of 35 or higher (or 32.5+ for certain ethnicities) - A BMI of 30–34.9 (or 27.5–32.4 for certain ethnicities) with specialist criteria It’s not recommended for pregnant or breastfeeding women or those with certain health conditions.

Duration: Continue semaglutide beyond 6 months only if you’ve lost 5% of your body weight. It’s prescribed for a maximum of 2 years.

Tirzepatide (Mounjaro)

Usually taken weekly, tirzepatide may be prescribed by a specialist or GP if suitable.

 When to Use Tirzepatide:  Eligible for adults with obesity and a weight-related health issue, or with a BMI of 40+ and at least 4 conditions (e.g., type 2 diabetes, high blood pressure, heart disease, dyslipidemia, obstructive sleep apnea). Lower BMI thresholds may apply based on ethnicity.  It’s not recommended for pregnancy, breastfeeding, or certain health conditions. If using oral contraceptives, use additional contraception (e.g., condoms) for the first 4 weeks and after dose increases. For hormone replacement therapy, consider patches or gels, as oral HRT may not be absorbed effectively.

Duration: Continue tirzepatide beyond 6 months only if you’ve lost 5% of your body weight. No specific time limit exists, but discuss continuation with a healthcare professional.