Best diet pills does not exist, just like there are no “best golf clubs”, “best purses”, or “best automobiles”. Every individual has different reasons for their weight gain and different responses to different medications. Each medication works on different areas of the body to control appetite,  cravings and fullness. However, there are many factors to help you and your physician when deciding on the best weight loss pills for you.

Medications for Weight Loss: Many Choices-Many Actions

Best FDA approved weight loss pills in 2021 include the older systemic appetite reducers including phentermine, Tenuate and phendimetrazine which have been available for more than  45 years and  similar new medications such as Qsymia and Contrave that have been on the market for 4-5 years. In the last year, two new medications have received FDA approval including Plenity which is a non-systemic  prescription medication that is not absorbed into the body exerting it weight reduction by producing fullness in the stomach and intestines.  A newer medication includes the semaglutides  Wegovy which is taken as a once a week injection and the oral form, Rybelsus which is a daily oral medication. The latter two medications produce weight loss by reducing appetite in the brain while delaying stomach emptying resulting in prolonged fullness.

Dr Lipman has written several short booklets on the newer weight loss medication including Qsymia, and Contrave. They are available on Alpha XR. Read a reviews of these Diet Medication Booklets.   Additional weight loss medications include Topirmate and Xenical.

Importance of FDA Approval for Weight Loss Pills

Currently 2/3 of adults and 1/3 of children in the US are overweight or obese. Therefore, there is great pressure on Food & Drug Adminstration and  the healthcare community—physicians and pharmaceutical companies alike—to develop new effective and safe treatments. The heart of all FDA medical product evaluation decisions is a judgment about whether a new product’s benefits to users will outweigh its risks. No effective product is totally risk or side effect free, so these judgments are important. Review side effects of weight loss medications such as mild insomnia. rare skipped or irregular  heart beats and dry mouth.

The FDA reviews the results of laboratory, animal, and human clinical testing done by drug companies. They use this information to determine if the product the company wants to bring to market is safe and effective. The average new medication takes more than 10 years and 10,000 or more test subjects to obtain FDA approval. Almost all medications become DEA controlled substances once the FDA approves them. There are several weight loss medications that are not controlled drugs including Contrave (a combination of wellbutrin(buproprion) and naltrexone, Plenity, Orlistat (Xenical), Topamax and Metformin.  Unfortunately, there are no FDA approved, effective drugs for weight loss that are Over the Counter, nor are any supplements proven to assist in weight loss. Many of the drug are known to reset metabolism and all have been proven safe and effective.

Classification of Diet Medications:  FDA  Approved Medications

Medications Producing  Weight Loss by Novel Mechanisms:  (Not necessarily by appetite suppression)

There are several FDA approved medications that assist in weight loss  by novel mechanisms not associated with appetite center stimulation such as Metformin, Topamax and Orllistat, Naltrexone and most recently Plenity.

Metformin:-The Cheapest of all Pills. The most interesting of these is Metformin which is used in diabetics to  control blood sugar. Metformin also improves metabolism. Metformin has been available for more than 20 years, is safe, is not a stimulant and can  be taken indefinitely. Recent studies suggest that besides limiting cravings the reduction of sugar and insulin release by metformin results in less fat formation and thus weight loss. In a recent study of 154 non-diabetic subjects weight loss averaged 12 lbs over the 6 month study. The authors concluded that “metformin was  an effective drug to reduce weight in a naturalistic outpatient setting in insulin sensitive and insulin resistant overweight and obese patients.” It exerts its effect by lowing insulin resistance.  It is the cheapest of all medications for weight loss. Often it is $5 or $10 dollars a month at many supermarket pharmacies  Another study found significant  weight loss in many overweight adolescents .  

Plenity: The weight loss pill Plenity was approved by the FDA in 2019 and has been available in some states since September 2020. Plenity is a safe and effective weight loss agent that works by producing fullness in the stomach. It is NOT absorbed into the blood and has no effect on appetite or craving centers of the brain. This makes the drug ideal for millions of people in the US that cannot take phentermine like appetite suppressors because of medical problems.  

Plenity works by expanding int he stomach and growing size in the stomach and intestines. Taken 20 to 30 minutes before eating the capsules break apart and the resulting hydodrogel cells absorb 100 times their weight from the water in the stomach.Plenity is taken as a three-capsule dose 20 to 30 minutes before you sit down for lunch or dinner. The result is that you feel full and have less room for food, thus you’re likely to eat less. After you eat, the hydrogel matrix moves out of the stomach, where it breaks down in the intestines. and releases the water back into the intestines.

Plenity treated  patients achieved weight loss of ≥ 5%, and 27% achieved ≥ 10% versus 42% and 15% in the placebo group,  . Patients with prediabetes or type 2 diabetes had six times the odds of achieving ≥ 10% weight loss. Because the body doesn’t absorb the hydrogel — it passes through the gut and out the end of the GI tract — the FDA considers it to be a “device,” not a drug. It is available only online from a national pharmacy www.gogomeds.com.  Read more about Plenity.  The cost of Plenity is $95 per month for 168 tablets.  Plenity is supplied in a capsule form and 2 or 3 capsules are taken with 16 oz of water before lunch and/or dinner.

Orlistat: Orlistat (OTC version Alli) with a brand name of Xenical works completely different than other weight loss medications. It inhibits pancreatic enzymes responsible for the digestion of fats, permitting the fats to pass out thru the gastrointestinal tract and thus reducing calories.

Topamax: Topamax is an older FDA medication used for seizures and migraine headaches it can be taken alone or more commonly taken in the prescription weight loss medication Qsymia.

Naltrexone: Another FDA medication that has been used to reduce alcohol consumption and cravings for sweets resulting in reducing calories is Naltrexone.  Naltrexone has been on the market for more than 20 years. it’s a very safe and effective medication especially for alcohol over-consumption. It works by blocking the opioid receptors in the brain which are activated by alcohol. Many individuals note reduction in need for sweet and salty comfort foods when taking Naltrexone.

Medications Producing Weight Loss by Effect on Brain and Appetite Centers

The FDA has tightly regulated the drug marketplace for weight loss medications. The vast majority of medications are not only prescription drugs but also DEA controlled substances because of their effect on the brain.  The DEA classifies these drugs into five categories, or schedules: I, II, III, IV and V. From the DEA:

Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs have a high potential for abuse and the potential to create severe psychological and/or physical dependence. As the drug schedule changes– Schedule II, Schedule III, etc., so does the abuse potential– Schedule V drugs represents the least potential for abuse.

The diet medications Qsymia, phentermine (including Lomaira), diethylpropion, and phendimetrazine are Schedule IV drugs. This means there is little to no abuse or dependency potential. A cough medicine with small amounts of codeine would fall under Schedule V. Narcotic pain medications such as oxycodone and fentanyl, as well as amphetamine-based ADHD drugs such as Adderall and Ritalin are in Schedule II.

1. There are NO FDA approved prescription weight loss medications in over-the-counter (OTC) drug or supplement groups.
2. There is only a single approved nonprescription medication for weight loss. It is called is Alli (Orlistat). Unfortunately, it is not very effective. Xenical is the prescription strength version of Orlistat.
3. Xenical and Contrave are the only FDA-approved prescription weight loss medications that are not DEA controlled drugs.
4. . Many of the above drugs work very well with the 500 or 800 calorie HCG diet. Human chorionic gonadotrophin   may be
   enhanced with some of these drugs.

Best Weight Loss Pills: Do I Qualify for Medication?

Weight loss pills are all medications requiring a prescription from a physician. Weight loss drugs may be an option for you if:

1. You are obese (BMI of 30 or higher)
2. You are overweight (BMI of 27 or higher) with serious health risks, such as high blood pressure, type 2 diabetes, or high cholesterol, and cannot control your weight with diet and exercise alone.
3. Other medical conditions are present, such as sleep apnea, severe arthritis, and even depression.

Try our simple BMI calculator to discover your Body Mass Index

These BMI thresholds reflect a recommendation that individuals be treated when their body weight was at least 20% above “desirable weight” based on Metropolitan Life Insurance data from 1983. A BMI of ≈27 for men and women corresponded to being 20% above desirable weight and was associated with increased risks for hypertension (high blood pressure), hypercholesterolemia (high cholesterol), and diabetes mellitus, as well as premature death.

How to Determine Best Weight Loss Pills for You

Many factors go into the process of deciding which are the best weight loss pills for you. Assuming your weight and/or medical problems indicate the possible need for these medications, your medical history is the first place to start. This includes current medical problems, medications, past history of medical problems, and previous reactions to medications. Here are the reasons we can exclude one or more of these medications:

1. Medical history that excludes use of prescription weight loss drugs:

Conditions include uncontrolled hypertension, heart failure, history of cardiovascular disease (heart attacks, TIA’s, strokes), terminal cancer, hyperthyroidism, and some cases of glaucoma.

2. Concurrent medications that exclude all 3 drugs (Qsymia, Belviq, and Contrave):

MAO inhibitors, seizure medications, a history of allergy to any of these medications, or you are currently taking similar medication or one of the two components in Qsymia or Contrave.

3. Concurrent medications that exclude a single drug ( Qsymia or Contrave):

1. Qsymia Contraindications: Dilantin
2. Contrave Contraindications: SSRIs, methadone, and opioid pain medication

4. Past History of Successful Weight Loss Attempts with a Weight Loss Medication, or Unpleasant Side Effects

Your past attempts at weight loss with medications, successful or not, are often ignored when deciding the best weight loss pills for you. Also frequently overlooked are unpleasant or intolerable side effects when taking components of some of these new medications for other medical problems. Older weight loss medications (diethylpropion and phentermine) have been on the market for more than 35 years, and the components of Qsymia and Contrave for almost equally as long. Your past responses, both positive and negative, can help you decide what new or old medication might be of assistance today.

Successful weight loss in the past with phentermine or diethylproprion might suggest trying these medications again at different dosages. It may also suggest Qsymia as a possible alternative. If you have been treated with buproprion (Wellbutrin) for anxiety or depression and noticed weight loss, you might consider Contrave. If you responded well to Zyban (a version of buproprion) and stopped smoking, you might also consider Contrave. Some dieters can lose up to a lb a day in the beginning.

On the other hand, if you have experienced unpleasant side effects when taking topiramate or phentermine (Qsymia components), or buproprion or naltrexone (Contrave components), then trying Qsymia, Contrave, or even the phentermine alone would be poor choices. Belviq might be the best choice in that case.

5. Your Age and Gender Often Help Decide the Best Weight Loss Pills:

Overweight and obese younger people (teens to mid-twenties) of both sexes and men who require weight loss medications but have never taken any of the older weight loss medications seem to do better when they take a single of the lowest dose medications in the morning. Older teens and men respond well to low dose phentermine or Tenuate, especially when the dosing is early in the morning and only once a day. Phentermine has been suggested to reset metabolism to higher levels.

6. Your Tolerance (or Intolerance) for Side Effects Helps Determine Your Best Weight Loss Pills:

All of these medications have some side effects. Most are transitory and mild. However, everyone responds differently and side effects are unpredictable. In addition, everyone has a different tolerance for side effects. In general, Qsymia has the most side effects and at the same time is probably the most effective. Contrave has fewer side effects. Side effects fall into several groups:

• Insomnia, stimulation, anxiety: Typical of the older drugs like phentermine. Less frequent with diethylpropion. Not a problem with Lomaira 8mg.
• Somnolence and fatigue: Not seen in the older weight loss drugs. Most commonly experienced with Qsymia
• Tingling of fingers, memory problems: Seen only Qsymia because of the topiramate component.
• Gastrointestinal issues, including nausea and (rarely) vomiting: Only in Contrave due to the naltrexone component.
• Headache: Possible with all of the medications. Usually transient and tolerable. Responds to extra strength Tylenol.

7. Your Eating Patterns Help Determine the Best Weight Loss Pills for You:

You may be overeating for many reasons. Often, trying to analyze what, when, and how much you eat can help you decide on the best treatment. Here are several types of eating patterns and the medication that might be the best to consider:

• Compulsive Over-eater
  A compulsive over eater is an individual who compulsively eats but does not purge and usually becomes overweight. The over eater may eat three meals a day plus frequent snacks. He or she thinks of food all day long. This person may overeat continually throughout the day rather than consume large amounts of food during intermittent binges. They tend to get stuck on the thought of food and feel compulsively driven. He or she tends to be a night time eater and typically claims to have no control over food. Often they worry and have difficulty falling asleep. This behavior has been associated with low levels of serotonin. Caffeine and older diet pills often make them anxious. The best weight loss pills for people in this category is often Qsymia (as long as they can tolerate the phentermine component) or Belviq.
• Impulsive Overeating
  An impulsive eater has poor impulse control and reaches for food often when he or she is not hungry and without thinking. They do well when they see healthy foods but have a hard time controlling urges when exposed to unhealthy foods. This is often seen in untreated ADHD. He or she has great difficulty adhering to a diet plan. This person will reach for the last piece of cold pizza slowly because it’s in front of them. Impulsive eaters usually reach for unhealthy food. The impulsive eating can occur day or night and is often unpredictable. The best weight loss pills for people in this category can be phentermine, diethylproprion, or Qsymia. A serotonin drug like Belviq may not be as effective.
• Sad, Emotional, Anxious, or Depressed Overeating
  Over-eaters with these emotional problems often overeat to calm down because they are depressed or sad. They often have depression and low self esteem. They will have feelings of negativity and hopelessness. The best weight loss pills for people in this category is often Contrave because of the effect of buproprion on depression. Belviq might also help when there are serious portion control problems as well. Medications working on serotonin in the hypothalmus of the brain seem better for this problem.
• Overeating is Associated with High Alcohol Consumption
  Over eaters that are drinking 2 or more alcoholic drinks daily or almost daily can do very well with Contrave. This is especially true if there are elements of compulsive behavior and depression, and if the alcohol triggers increased appetite and lowering of inhibitions. The centers in the hypothalmus that control alcohol and food (especially carb) cravings are very close together.

Differences Among Weight Loss Medications

 Want to Read More About These Medications?

Learn More With Our Medication Quick Reference

Read Dr Lipman’s Book: Contrave, Qsymia or Belviq: Which is the Best New FDA Approved Weight Loss Medication?

5.0 out of 5 stars – A Smart Look At Some New Medications

Contrave, Qsymia or Belviq: Which is the Best New Medication? Is loaded with insight and a clear to understand direction to the secrets behind unlocking permanent weight loss. I really liked how sharp and clear Doctor Lipman is throughout the entire book. You have to keep up with what he is going over, but you never feel lost.

I had been considering bypass surgery, but due to some health issues started to see a lot of weight loss. After a year, and sixty-five pounds in weight loss, I am always looking to be informed about all the key tools and aids that can help, I don’t want to gain any back. I hope everyone reads up on all the new FDA approved medications, there are thousands of people that need to improve their health and get their weight under control.

It was encouraging to see the breakthroughs and better understanding of the different receptors that produce fullness, a sense of being satisfied, and the inner workings of cravings and how to reduce and control them. I also really liked all that is covered with each medication regarding the side effects, really helps you zero in on what might have the best results. A wonderful read, information that you can start to take action from and move forward with a clear understanding”.

By D Roberts on May 19, 2015

Call 305-670-3259 to Make an Appointment with Dr. Lipman in his Miami Office