Ask Your Pharmacist

January 13, 2021
Q:

Are there any prescription weight loss products out there that work?

A:

Happy New Year! Your question gave me the chance to review recent advances in prescription medication therapy for obesity in Canada.

Obesity is a complex disease of abnormal or excess body fat that impairs healthy living. Obesity is a major health concern in New Brunswickers. According to statistics Canada data (2016-2017), New Brunswick is tied with Newfoundland and Labrador for the highest prevalence of obesity in Canada at 38 per cent (compared to the national prevalence of 27 per cent).

Excess body fat (i.e., adipose tissue) puts us at higher risk of type 2 diabetes, gall bladder disease, non-fatty liver disease, gout, and several types of cancer. It also affects our self-image and self-esteem, and unfortunately contributes to stigma and bias against those who are over-weight.

A lot of the information I found originated from the Obesity Canada website. I encourage you to look at their website: https://obesitycanada.ca/managing-obesity/prescription-medications/ .

It is not as simple as taking a pill to lose weight. The key to obtaining and maintaining a healthy weight is to treat the root cause(s) of obesity. Medication therapy is officially indicated for those people with a diagnosis of obesity or morbid obesity. Prescription medication therapy can help increase the weight loss achieved from making healthier nutrition choices and increased physical activity. It also can be a tool used to help prevent weight regain. In many, if not all cases, counselling with a registered psychologist greatly increases your chances of getting to the heart of the matter, and I strongly encourage it. 

There are three medications approved for long-term obesity management in Canada: liraglutide 3.0 mg (Saxenda®), naltrexone/bupropion in a combination tablet (Contrave®) and orlistat (Xenical).

These medications can help you to achieve and maintain a five to 10 per cent weight loss and improve health complications associated with excess weight. These medications are approved by Health Canada and have been proven in clinical trials to be effective for obesity management. Medications that are not approved for obesity treatment may not be safe or effective for obesity management and should be avoided.

The exact way that ContraveR (naltrexone HCl /bupropion HCl) works is not known. Experts think the drug acts in the appetite control and reward centers of the brain. Dosing starts at one tablet each morning and is gradually increased as tolerated to two tablets twice daily over the course of the first month of therapy. The first month of therapy costs approximately $160 and subsequent months cost approximately $320. People with uncontrolled blood pressure should not use this medication.

Saxenda® (liraglutide) is thought to help patients lose weight by decreasing appetite and the amount you eat. Saxenda is a medication which is to be self-administered subcutaneously daily, using a pen similar in appearance to an insulin pen. A one-month supply is approximately $410. 

In order for fats from foods you eat to be absorbed into the body, they need to be broken down by enzymes called lipases. When Xenical® (orlistat) is taken with meals, it prevents these enzymes from working and causes a decrease in the amount of fat your body absorbs from your food. When you absorb less fat, you take in fewer calories, leading to weight loss. Xenical® does not decrease or change your appetite. The monthly cost of Xenical is approximately $170.

None of these medications are covered by the NB Prescription Drug Program or by most private insurers. Patient support programs are available in some instances by the manufacturer to help off-set the cost of these medications.

Talking about your weight is deeply personal. You can trust that your pharmacist will be sensitive to your questions, and I bet taking the step to discuss your weight with your pharmacist will help foster trust between you. Before a decision is made about whether any of these medications is a good fit for you, consult your doctor or nurse practitioner. It is likely that these health professionals will also invite the expertise of a registered dietitian and psychologist. 

Congratulations to the many New Brunswickers this January who will take on the challenge to lose weight.

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.