All You Need to Know About Weight Loss Medicine

Championing the first place as the most obese country in the Southeast Asia region, 50.1% of Malaysian adults accounted for obesity; with 30.4% who were overweight and 19.7% who were obese (National Health and Morbidity Survey, NHMS 2019). Being a multiethnic country with people of different cultures and foods, it is no wonder that Malaysians bond well over a variety of meals. However, it is also unfortunate that these foods contribute largely to the emerging obesity cases in our country. The Health Ministry has warned that this matter is waving a red flag if not tackled properly.

Image source: Klinic Low

Image source: BORNEO POST online

Obesity should not be taken lightly, in fact it is seen as a public health concern as there are many health risks that are associated with obesity such as hypertension, diabetes, dyslipidemia, heart diseases, sleep apnea, osteoarthritis and so on.

How are overweight and obesity defined? 

All You Need to Know About Weight Loss Medicine

The good news is, it is never too late to start losing weight as long as the motivation and drive remain. While most would turn to conventional measures such as frequent exercises, and incorporating calorie deficit diets in their meal plans to lose weight, there are also other medical alternatives that one can opt to facilitate their weight loss process, especially if they’re also suffering from other obesity-related medical conditions. Let’s look at them!

In Malaysia, there are a few weight loss options that are available in your local pharmacy where you can get it either with or without a prescription (OTC products).  

Prescription Only Medicines

There are two kinds of prescription only medicines approved and registered for weight loss in Malaysia, namely peripherally acting anti-obesity drugs and centrally acting anti-obesity drugs.

a) Peripherally acting anti-obesity drugs
Eg: Lipase Inhibitor - Orlistat (Xenical/ Aslene)

To date, Orlistat is the only lipase inhibitor approved as a weight loss treatment. It inhibits pancreatic lipase (an enzyme responsible for fat hydrolysis) from being absorbed, thereby decreasing fat absorption. This undigested fat is then excreted as feces during bowel movements. 

What is the indication for Orlistat?

Orlistat is used to treat obesity which includes weight loss as well as weight management in individuals with BMI ≥27 kg/m2 who are at risk of developing conditions such as hypertension, diabetes, dyslipidemia. Studies have approved Orlistat use for up to 4 years with no adverse side effects. 

This medication is recommended to be used as an integral component of a comprehensive weight control programme that encompasses physical activity, a nourishing diet, and lifestyle modifications. 

How do you take Orlistat?

Orlistat is usually taken three times a day, 1 hour after each main meal that contains fat. It is important to note that your meal should not contain more than 30% of calories from fat each time you consume Orlistat.

Because Orlistat blocks the body's uptake of fats, including reducing the absorption of fat-soluble vitamins (Vitamin A, D, E, K, and beta-carotene), it is advisable to take a daily multivitamin supplement that contains these vitamins to ensure you do not suffer from vitamin insufficiency."

b) Centrally acting anti-obesity drugs
(i) Norepinephrine agents - Phentermine (Duromine)

Phentermine is a medication that reduces appetite by acting on the appetite-regulating centers in the brain to lower the craving and desire to eat. It is only recommended for short-term use (<12 weeks; 3 months) as it is thought to be habit-forming and some studies have linked long-term usage to increased risk of cardiovascular events and/or behavioral changes.

How do you take Phentermine?

Phentermine comes in extended-release capsules and is taken as a once daily dose in the morning before breakfast.

Side Effects

Some common side effects from the use of Phentermine include dry mouth, diarrhea , and headache. In more severe cases, patients have also complained of hypertension, heart palpitations, tremor and chest pain. If you notice any of these symptoms after taking Phentermine, it is advisable that you seek medical treatment right away.

(ii) Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists -  Liraglutide (Saxenda)

More commonly known for its indication as an anti-diabetic agent, GLP-1 receptor agonists act centrally in the brain by binding to GLP-1 receptors where the drug would stimulate the sensation of fullness even with the consumption of small amounts of food. In addition, this medication also delays the emptying of the stomach causing prolonged satiety, suppressing hunger and reduced food intake. 

Just as the previous two, Saxenda is used as an adjunct to a reduced-calorie diet and increased physical activity in individuals who are obese (BMI ≥30 kg/m2 (obese) or overweight with BMI between 27 to 30 kg/m2 with at least 1 weight-related comorbidity. 

Image source: HEALTHCare Today 

How do you take Liraglutide?

Liraglutide comes in the form of a subcutaneous injection where it has to be taken once everyday irrespective of meal times.

Side Effects

The most common side effect from Liraglutide include nausea, vomiting, injection site reaction, low blood sugar (hypoglycemia), and dizziness.

Over the Counter (OTC) Products

Most of the over-the-counter (OTC) products available in the market, which do not require a prescription, are often health supplements that claim to work due to the following mechanism:

• inhibit the absorption of fats into your body
• exist in the form of fiber that stimulates bowel movement and slows down digestion
• milk formulas that serve as a meal replacement or
• increasing metabolism rate

They are also typically encouraged to be taken whilst complying with a strict calorie-controlled diet with regular exercises for a more sustainable and promising outcome.

With the rising cases of obesity in Malaysia and the subsequent awareness of slimming products, some sellers may take advantage of these vulnerable groups of people and create counterfeit products to maximize their profit. Hence, it is wise to always check if the product you're buying is registered with the National Pharmaceutical Regulatory Agency (NPRA) at QUEST 3+ Product Search. 

Moreover, some of these products may contain ingredients that may not be suitable for certain groups of people such as those who are taking blood thinning medications (e.g., aspirin, clopidogrel, rivaroxaban, apixaban, dabigatran) or other medications that may result in drug-herb interaction. Always consult your physician or inform your pharmacist before consuming them.

In conclusion, the weight loss medications mentioned above are usually indicated in obese patients who also suffer from another weight-related medical condition, such as hypertension, type 2 diabetes, or high cholesterol. Healthy individuals who have a body mass index (BMI) that classifies them as overweight or obese should always try to lose weight healthily through conventional measures, such as incorporating a balanced, low-carb diet, taking regular meals, engaging in routine exercises, increasing dietary fiber intake, and drinking 8 glasses of water a day. Patients who are on these anti-obesity agents should not expect and be dependent on the drug alone to help them reduce their weight.

To quote one of the most commonly used Malay proverbs, "Badan Cergas, Otak Cerdas," which translates to a healthy body leads to a healthy mind. Let us work together for a healthier future with reduced disease burden and an improved quality of life.

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US)
reviewed by Ashwini Nair, MB BCh BAO 

References

1. Obesity, Principles of Therapy - MIMS Malaysia. Available at: https://specialty.mims.com/obesity/treatment. Accessed on 2nd March 2023
2. Slimming Pills - MyHEALTH KKM. Available at: http://www.myhealth.gov.my/en/slimming-pills-2/ Accessed on 2nd March 2023
3. World Obesity Day - WHO. Available at: https://www.who.int/news/item/04-03-2022-world-obesity-day-2022-accelerating-action-to-stop-obesity#:~:text=More%20than%201%20billion%20people,adolescents%20and%2039%20million%20children. Accessed on 2nd March 2023
4. Weight Loss - Mayo Clinic. Available at: https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832. Accessed on 2nd March 2023

Written by

Janelle Leong, Bpharm(Hons)