This is a snapshot of the weight management medication that might be considered.Choosing the right medication is individualised according to patient needs and existing medical conditions.Combinations of medication and dosage adjustment is important for efficacy and tolerability.Although these medications are proven useful in the short to medium term for weight loss, not all have not been approved for this use in Australia.Metformin (antihyperglycaemic) Especially for weight gain related to depression and anxiety medication.GLP1s (eg tirzapetide, liraglutide, semaglutide, duraglutide)Used to help control hunger, appetite and portion sizeSlows stomach emptying, increases insulin, decreases glucogonTrading as Mounjaro, Saxenda, Ozempic, Trulicity, Wegovy.Phentermine (sympathomimetic stimulant) For sweet cravings, also used for fatigue, short term use only, is related to amphetamine. Often used in combination with Topiramate.Trading as Duramine.Topiramate (anticonvulsant) For sweet cravings, taste changes and headaches.Often used in combination with Phentermine. Decreases leptin and decreases appetite. Used more usually for epilepsy and migraines.Trading as Topamax.NDRI ANTIDEPRESSANTS (Eg Wellbutrin, Bupropion) For improved mood, for fatigue and helps with some cravings. Also used to help stop smoking and to treat depression.Trading as Zyban.Naltrexone (narcotic antagonist)For help with cravings and frequent snacking, used also in alcohol and opioid addiction. Used in weight loss at low doses.Trading as Contrave.
The most frequently prescribed medication in our clinic is Mounjaro (tirzapetide). Key Points:
This is a dual action drug that mimics the body’s own GLP1 and GIP (which are gut hormones), and results in decreased hunger, increased fullness, improved sugar metabolism and reduced weight. It is a weekly injection. It is available to assist weight control in certain patients and is approved for this use in Australia. The weight loss with Mounjaro is typically around 10% to 15% total body weight loss.Compared to other similar medication this is the drug of choice in our clinic because it is the only one with this dual action, it is approved for weight management in Australia, and because it achieves typically faster and greater weight loss compared to the other injections in this drug class (Ozempic, Wegovey, Saxenda, Trulicity)
Patients often experience effects like decreased hunger, increased fullness, decreased cravings, decreased tendency to give in to cravings, decreased eating of treats and decreased food noise and increased weight loss.The starting dose of Mounjaro is 2.5mg. The dose is reviewed with the doctor once per month. The dose is adjusted to balance the desired decrease interest in food and weight loss with side effects. Side effects are more common with starting the medication or a new higher dose. The intention is that the medication is used long term. Best results are achieved when the medication is combined with lifestyle and eating changes. We encourage our patients to maximise their results with Mounjaro by checking in with the dietitian for important tips to increase weight loss, weight loss maintenance and minimising muscle loss. Another key requirement is regular follow up with the doctor to check for side effects, the impact on food habits and weight loss and adjusting the dose. These are done monthly or more frequently if required. We are able to do these repeat dosing consultations with the doctor remotely by phone or video consultation.
People should consider adding Mounjaro to their weight loss strategy if they have a weight problem that is affecting their health, their mental health, self-esteem or quality of life. It is used in combination with a healthy lifestyle and good food choices. (It is also very effective in type 2 diabetics, but this is not the specialisation of our clinic.)We are using Mounjaro with both our weight loss surgery patients and our regular / non-surgical weight loss patients. We consider Mounjaro in patients who have a milder weight problem, are not fit for surgery, do not like the idea if surgery, or feel they need to give it a go before looking into surgery. It can also be used to lose weight as a way of preparing for weight loss surgery.It is an alternative to surgery in some patients. The typical total body weight loss is 10% to 15% (compared to Sleeve 30 to 40%) and it takes 12 to 18 months to lose large amounts of weight, which is 3 to 4 times longer than with a Sleeve. Also, by comparison, the weight is far more likely to be regained once stopping (around 80% will regain their weight). This is less likely when lifestyle and dietary changes are maintained, hence the importance of the input form the dietitian.
It is intended that people go on Mounjaro long term in most cases. However, most patients do end up stopping it at some point. The most common reasons people give for stopping Mounjaro are intolerable side effects, the high cost, dissatisfaction with weight loss, concern about serious side effects and dislike of repeated injections. The other common reason is that people feel the weight loss has stopped, so why keep taking injections, especially when they feel they have straightened out any lifestyle and eating issues.
Mounjaro comes with the same warnings as other similar drugs. Common side effects are nausea, vomiting, diarrhoea, constipation, and abdominal pain. Serious risks to be aware of include pancreatitis, gallstone problems and dehydration and subsequent kidney injury. Mounjaro is not to be used by anyone with a personal or family history of Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). It is not for use in type 1 diabetes. It interferes with the oral contraceptive pill rendering it ineffective in many for contraception. (Patients should not rely on the pill four weeks after starting treatment and after each dose increase.) It is not recommended during pregnancy or breast feeding (due to lack of safety data). This is not an exhaustive list of warnings and side effects.
In our experience, patients with a Sleeve can consider using Mounjaro if they are struggling with inadequate weight loss, excessive weight regain or disappointing speed of weight loss. Patients often experience effects like decreased hunger, increased fullness, decreased cravings, decreased tendency to give in to cravings, decreased eating of treats and decreased food noise and increased weight loss. The dose of the medication tends to be lower in our sleeve patients than the general patients. Also, they invariably describe the sensation of being like it was when they first had the sleeve surgery.When the weight loss of a Sleeve is supplemented with Mounjaro the weight loss often increases. However, there is ongoing debate among doctors regarding the ideal timing and the role of Mounjaro in Sleeve patients. We therefore need to consider each patients needs individually. With regards to inadequate weight loss and slow weight loss post Sleeves and whether to add Mounjaro, in our experience, patients with this issue often regret not having had the conversation and at least considering adding Mounjaro. We suggest at least considering Mounjaro earlier rather than missing the opportunity and then being worried that it might be too late.We are finding many subtle differences in the use of Mounjaro in our sleeve patients compared to regular weight management patients. For example, extra care in dosing and modifying eating patterns to avoid vomiting (Mounjaro slows the stomach emptying). Although the results of Mounjaro with a Sleeve are still being examined scientifically, it would appear to be very effective in our experience.The most common reason for stopping Mounjaro in our Sleevers are intolerable side effects in particular vomiting, the high cost, dissatisfaction with the amount of additional weight loss in some patients, concern about serious side effects (such as those listed above) and dislike of repeated injections. Many patients stop it when they feel they have achieved their goals.
Please Contact Melbourne Bariatrics on 03 9770 7189 for more information or to make an appointment.