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Losing weight with medication

21 April 2021 Blog
Bariatric surgery
Many people assume bariatric surgery is the best option for weight loss, but as St John of God Murdoch Hospital weight loss surgeon Harsha Chandraratna explains, there are many alternatives - medical and non-medical.

Bariatric surgery will always be the most durable form of weight loss, but surgery is not the answer for everyone. Many people aren’t suitable for surgery or don’t want to have an operation.

Luckily, we have an array of medications to support clients through the weight loss process. The research data consistently shows that a diet and exercise program is much more effective when combined with weight loss medications and a support program.

So what medication options do I have?

Duromine:
This is an amphetamine derivative, it has been on the market for over 50 years as weight loss agent. Because of it’s amphetamine origins it has a limited stimulant profile. This can give someone a lot of energy and motivation to get work done, but some people can feel anxious, stressed or become grumpy. It can also increase blood pressure and this should be monitored. Insomnia can also be an issue and a gentle sleeping tablet may be useful. It is safe to be used in the long term and costs $125/month.

Contrave:
It's a new medication that has been on the Australian market for two years and is combination of two old drugs: Naltrexone, which is used to reverse the effects of opiate medication and seems to help with controlling cravings for food and Bupropion which is an old antidepressant and is currently also used in smoking cessation under the trade name Zyban. Contrave seems to work best in controlling cravings and clients that have issues with chocolates, alcohol or carbohydrate cravings are ideal candidates for this medication. Contrave should not be used in people that have an acute head injury or a tendency to have seizures. It’s a little more expensive and costs $250 a month.

Saxenda:
This is a mimic of a natural hormone made by the pancreas and resets the set point in the brain to a lower weight. It also suppresses appetite, makes you feel full faster and keeps you full longer. It has an impressive safety profile and the only side effect is nausea that lasts for a few days when starting the medication or increasing the dose. Its safety profile makes it ideal for patients with cardiovascular risk factors, costing $387/month.

Xenical:
Xenical binds fat in the diet and stops the fat from being absorbed by the gut. This results in an oily diarrhoea with terrible flatulence. So clients learn not to consume fatty foods. It is very safe to take and may help people that have issues with constipation. It costs $130 a month.

So what else can I do?

There are also some other things that will help you on your weight loss journey.

Very low calorie meal replacements:
These are made by numerous companies and finding one you like is the key. If you like the taste and preparation, you are more likely to stay on it. The cost also varies from brand to brand.

The idea is to replace a meal with the very low calorie meal replacement milkshake, bar or dessert. The critical thing is to check the calorie content, for example, Optifast has 840kJ/serve, The Man Shake has 865kJ/serve and Optislim has 697kJ/serve.

For long term use, replace one or two meals a day and maintain a low carbohydrate or ketogenic approach for anything else consumed during the day.

Bluetooth scales:
A convenient way of tracking your progress is essential. Find scales in your price range with a Bluetooth app on your phone. The scales are very important to track your progress in the longer term, especially when you are in the maintenance phase of your program.

Find a Friend:
Friends are important and travelling the journey with a friend really helps, it makes you accountable and the journey much more fun.

So, if you need to lose weight, have a chat to your GP about the best option for you.

Dr Harsha Chandraratna
A/ Prof Harsha Chandraratna - General surgeon
Associate Professor Harsha Chandraratna is a general surgeon at St John of God Murdoch Hospital, with specialities in bariatric and weight loss surgery.