Tabloids almost weekly feature “weight loss medications” in headlines, or at least in gossip. Sometimes a celebrity’s weight loss is reported, and sometimes there’s alarm that medications are being taken away from diabetics.
But what is the truth behind these weight loss medications? Who can be prescribed them, and do they magically make everyone lose weight? This article provides important information before seeking a doctor’s appointment if you are considering medical treatment for obesity.
Obesity Has Become a Pandemic
Over a third of the world’s adult population is overweight or obese. The prevalence of obesity has doubled since the 90s, and the trend shows no signs of slowing down. This obesity pandemic is a complex phenomenon rooted in structural changes in society during the 20th century.
The development of modern society, such as the proliferation of industrially produced, high-calorie, and processed foods, the rapid advancement of technology that reduces the need for physical activity, and urban planning that often favors driving over active movement, have created an environment where both inactivity and an obesogenic diet are usually the easiest choices to make. Making a “healthy” choice often means more effort, slower access to places, or a higher cost. Individual choices are not the cause of the obesity pandemic, but rather a consequence of changes in our living environment.
The Struggle against Overweight is not Easy
Resolving obesity is not as simple as merely deciding to make healthier choices than what society easily directs. A significant portion of people struggling with obesity have been working diligently for years or decades. They have strived to choose the healthier option to lose weight, investing a lot of sweat, tears, and money in this endeavor.
The primary treatment for obesity is planned lifestyle therapy, implemented over several appointments. It addresses issues related to eating and diet, exercise and physical activity, sleep, psychological well-being, and resources.
Obesity medication can serve as a supportive method for lifestyle changes. Medication can also be initiated after weight loss to maintain the achieved weight.
Obesity can also be treated surgically if other treatments do not yield lasting weight loss results.
For some, traditional lifestyle interventions for weight management are sufficient, which is great for these individuals. However, for many, weight loss results are either minimal or short-lived, even with the help of weight management programs, professionals, and support groups in lifestyle therapy. Failure to lose weight is usually not due to a lack of motivation or effort.
Obesity medications have received a lot of attention in recent years, and deservedly so. For many, these medications offer hope for a completely new kind of help with a problem that has been unsuccessfully addressed for a long time. Since the 2010s, significant, even revolutionary, advancements have been made in obesity medications. Several medications have entered the market that have been scientifically proven to significantly aid in weight loss and improve health.
Next, we provide general information about obesity medications currently available in Finland.
Medications Make Reducing Food Intake Easier
Different obesity medications are designed to act in a few different ways. Common to all of them is that they do not cause weight loss on their own, but rather facilitate the reduction of food intake. The medications help reduce feelings of hunger and induce a sense of fullness more quickly. This leads to a reduction in caloric intake from food without the experience of hunger becoming overwhelming.
Medications also have psychological effects that support weight management-related behaviors. For example, they can reduce the intensity of cravings, making it easier to avoid unhealthy treats. This can be particularly valuable for those struggling with emotional eating.
Benefits for both Weight Loss and Health
Obesity medications not only reduce weight but can also improve the management of several co-morbidities, such as type 2 diabetes and cardiovascular diseases. Some obesity medications have been shown to reduce the risk of heart attacks and strokes.
The Amount of Weight Lost Varies
Regardless of the chosen medication, it is currently not possible to predict for an individual how much weight will be lost or if the medication will work at all. Individual differences are very significant. The medication and its strength are chosen together with the treating physician, monitoring the response.
The choice of medication may be influenced by obesity-related co-morbidities such as diabetes, elevated cholesterol, or high blood pressure, the severity of obesity, contraindications to medications, and other factors. Patient preferences are also taken into account in the selection. In research settings, currently available medications have resulted in an average weight loss of 5 – 23%, but for individuals, weight loss can be significantly greater or smaller than this.
There are Medications on the Market that Act through Two Different Mechanisms
The first mechanism involves medications that act similarly to certain gut hormones, i.e., GLP-1 agonists, which include, for example, Wegovy®. Another mechanism of action is found in tablet formulations Mysimba® and Qsiva®.
The Gut Hormone GLP-1 Increases Satiety and Lowers Elevated Blood Sugar
GLP-1 agonists, or incretin mimetics, were originally intended for the treatment of type 2 diabetes, but because they also have a significant weight-reducing effect, they have been further developed specifically for the treatment of obesity. The active substances are the same for both obesity and diabetes treatment, but the dosages are higher.
GLP-1 Hormone-Like Medications Approved for Obesity Treatment:
- liraglutide (Saxenda®), which is Kela-reimbursable
- semaglutide (Wegovy®)
- tirzepatide (Mounjaro®)
These medications work by slowing down intestinal movements and gastric emptying, thereby increasing the feeling of fullness. They also directly affect hunger regulation through the brain.
Why then is Ozempic, widely reported in the media, not actually an obesity medication? Although the active substance, semaglutide, is the same in both Ozempic and Wegovy, only Wegovy has obesity treatment as an official indication.
Tirzepatide (Mounjaro®) acts like both GLP-1 hormone and GIP (gastric inhibitory polypeptide) hormone, which enhances its hunger-reducing effect and may alleviate the medication’s side effects.
Who are GLP-1 Medications Suitable for?
GLP-1 medications are generally the primary choice, especially if the patient has type 2 diabetes or prediabetes, high blood pressure, and/or elevated cholesterol in addition to obesity. The medications are self-administered as a subcutaneous injection once a week using a pen-like applicator, or as a tablet in the case of Rybelsus®.
If you suspect you have diabetes, take our quick Diabetes Risk Test on our website.
What Symptoms Can Obesity Medication Cause?
Possible side effects may include nausea, vomiting, heartburn, and constipation. Rarer but more serious side effects can also occur, including pancreatitis and gallstones.
These medications officially have no specific contraindications other than allergy to the active substance or excipients, but medication must be considered with particular caution in those who have had pancreatitis.
Kela Reimbursement for Obesity Treatment
For obesity treatment, Saxenda® may be eligible for Kela reimbursement if the BMI is at least 35, blood sugar is elevated, and there is medication for blood pressure or cholesterol. Further reimbursement eligibility is granted only if weight loss is sufficient (5%) in the first months, and reimbursement must then be reapplied for once its effectiveness has been demonstrated.
Mysimba® and Qsiva® Affect the Central Nervous System
Another mechanism of action is found in a tablet formulation where the active ingredients are bupropion and naltrexone, marketed as Mysimba®.
Bupropion was originally developed as an antidepressant and often has a stimulating effect. It is also used as an aid for smoking cessation. Naltrexone is an opioid receptor antagonist, and through partly unknown mechanisms, these together affect the brain’s hunger and reward centers, reducing food intake.
Qsiva® also affects the central nervous system. The active ingredients in Qsiva® are topiramate, used in the treatment of epilepsy and migraines, and phentermine, which is used alone for obesity treatment in the USA but not in Europe. Although neither phentermine nor topiramate are new drug molecules, their exact mechanism of action for weight management is not known.
Who is Mysimba® Obesity Medication Suitable for?
Clinical experience and individual scientific studies suggest that Mysimba® works particularly well as an emotional eating inhibitor, but its indication is still general obesity caused by other eating behaviors.
Possible Side Effects and Kela Reimbursement for Mysimba®
Common side effects include nausea, vomiting, constipation or diarrhea, dry mouth, dizziness, headache, and difficulty sleeping. Contraindications for the medication include bipolar disorder and epilepsy. Mysimba has some interactions with other medications, such as several antidepressants.
Mysimba® may be eligible for Kela reimbursement if the BMI is at least 40, or if the BMI is at least 35 and the patient also has medication for type 2 diabetes, elevated cholesterol, or high blood pressure.
Who is Qsiva® obesity medication suitable for?
Qsiva® may particularly help those whose portion sizes easily become too large, even if they have eaten sufficiently earlier in the day.
For people who can become pregnant, it is especially important to ensure they are not pregnant when starting Qsiva® medication, and a reliable method of contraception must be used during treatment.
Possible side effects of Qsiva®
The most common side effects include tingling in the fingers, fatigue, gastrointestinal symptoms, and difficulty concentrating. Qsiva® also has several interactions with other medications.
Over-the-counter Obesity Medication – Orlistat Prevents Fat Absorption
Among the medications described here, orlistat, which has been on the market the longest, inhibits the action of fat-digesting enzymes produced by the pancreas. Thus, fat is not absorbed into the body but excreted through the intestines. Orlistat has been shown to improve weight loss results, improve blood cholesterol levels, and reduce the risk of diabetes, but its weight-reducing effect is relatively minor compared to newer medications.
Consistent with the drug’s mechanism of action, possible side effects include fatty diarrhea, especially in conjunction with overly fatty meals, and deficiencies of fat-soluble vitamins. Therefore, it is recommended to take a multivitamin tablet with it. The use of the medication has decreased as new, more effective ones have entered the market. Orlistat is also available over-the-counter at pharmacies.
Table: Medications for the Treatment of Overweight and Obesity
| Active substance | Trade name | Mechanism of action | Kela reimbursement for obesity treatment | Notes |
| liraglutide | Saxenda | Gut hormone |
| Injected daily |
| semaglutide | Wegovy | Gut hormone | No | Injected weekly |
| tirzepatide | Mounjaro | Gut hormone | No | Newest gut hormone class medication, injected weekly |
| bupropion-naltrexone | Mysimba | Affects the central nervous system |
| Drug interactions. May help in managing emotional eating. |
| topiramate-phentermine | Qsiva | Affects the central nervous system | No | May cause difficulties with concentration and memory. May help in managing portion sizes. |
| orlistat | Orlistat Sandoz/ Orlistat Stada | Fat absorption inhibitor | No | No prescription needed |
New Medications are Coming
Pharmaceutical companies are feverishly developing new medications for obesity treatment. Drugs in the research phase have preliminarily been shown to yield an average weight loss of up to 25%, which already approaches the efficacy of bariatric surgery. Most of the promising new drugs in development are molecules similar to gut hormones.
Quality Lifestyle Therapy is Important, whether You Use Medication or Not
If you have not previously consulted a healthcare professional regarding obesity treatment but have only tried independently, we still recommend non-pharmacological professional help for lifestyle changes. The decision on medication does not often need to be made at the first appointment.
Professional guidance for healthy weight loss and your experience in implementing it also help in choosing the right medication and preventing problems related to drug therapy. After all, diet and exercise plans are the same for you, whether medication is used or not – medication may simply make these changes easier to implement. Therefore, these plans should still be made when starting medication.
Obesity Medication Can be Part of Long-Term “Basic Medication”
Medications are used for high blood pressure and elevated cholesterol to reduce the risk of heart attacks, strokes, and death. In 2017, approximately 28% of Finns over 30 reported using blood pressure medication. Among those aged 30–74, 17% of men and 12% of women used cholesterol-lowering medications. Both are therefore widely used medications.
Obesity medications have also been shown to reduce the risk of these same serious diseases for which blood pressure and cholesterol medications are used. Furthermore, the reduction in obesity also brings additional benefits such as fewer knee pains, more agile movements, and much more.
Another argument for continuing effective and well-tolerated obesity medication is that, almost without exception, most of the lost weight returns if the medication is stopped. The medication therefore works as long as it is used, just like blood pressure or cholesterol medications. Although obesity medications also have their potential side effects, for properly selected patients, the benefits generally outweigh these harms many times over.
Wouldn’t it therefore be natural for medications in obesity treatment to be regarded similarly as a normal and long-term treatment, just like in the treatment of blood pressure and cholesterol?
Building on a Sustainable Foundation
Good obesity treatment always starts with taking care of one’s own well-being. This desire to maintain one’s physical and mental well-being is necessary for successful healthy weight management. Sometimes, despite good intentions and hard work, weight management is not successful, and in such cases, it is beneficial to seek external help. For some, medications may be precisely the support needed to implement the health-promoting changes they have long strived for.
Painoklinikka Helps in Finding Suitable Medication
If you are considering whether medication would be a good aid for your weight management, book an appointment with Painoklinikka’s doctors. You will receive an expert assessment and, if necessary, prescriptions and medical statements related to your medication.
Painoklinikka also provides professional monitoring for your medication and various forms of support for lifestyle changes.
Matias Blomqvist
Weight Management Physician
(Update November 8, 2024: the title has been modified to better reflect the content of the text.)
