What Medications Lower Your Set Point?

hi I'm dr. whiner

I'm a bariatric surgeon and I also

answer people's questions that they have

about bariatric surgery or weight loss

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today's question hello dr. wana you

mentioned medications when you're

talking about the metabolic setpoint and

metallic metabolism what are the

medications that can help with that

hormonal response with your girl in your

leptin can you please tell us what those

medications might be thank you okay so

what medications lower your setpoint I

go and do this and actually pretty

significant amount of detail in my new

book how weight-loss surgery really

works it's chapter 4 but I'll go over

those quickly some of the medications

that are used for weight loss in the

United States so metformin is a diabetes

medicine it's it's not a very powerful

set point lowering agent to some degree

I think it just causes some underlying

GI disturbances and unpleasant side

effects and just that kind of illness

that GI illness that it triggers tends

to kind of lower your set point and

drive a little bit of weight loss but as

far as a powerful weight loss medication

I definitely wouldn't put it there the

good thing about it has very few side

effects aside from those GI issues and

it's very cheap phentermine also known

as a DAP axe or some other versions of

it like fend I met Rosine these are

stimulants which are very common a lot

of people dose them pretty high and you

can get fast heart rates and difficulty

sleeping and all kinds of anxiety and

unpleasant side effects when I use them

I tend to do some lower down and keep


people on them for a long period of time

it's a great drug you can lose a some

weight from it but in terms of staying

on it it just doesn't have the

durability or long-term success rate

that we need from a weight loss

medication if you stop taking it the

weight gain comes right back on and

really it's not safe to stay on forever

and over time your body kind of adjusts

it and it doesn't work as well

there's Topa mairead or topamax which is

an anti-seizure drug which is often

coupled with then termine which can in

it's put together in a combination pill

called Kusa mia and it's it doesn't have

a ton of side effects some people can

get a little Spacey from it but in

general is a fairly safe medication and

the two of these together kind of work

they work well and we can see 15 20 25

pounds of weight loss from these

medications sometimes even more but for

most people you're looking at somewhere

between between 10 to 20 pounds of

weight loss from a combination of these

medications Contrave is a combination of

bupropion which is also known as


and now trek zone which blocks the

opioids it's similar to narcan which is

what the firemen used to treat people

who have overdosed from narcotics and

the idea here is that it kind of reduces

your cravings for sweet foods and allows

you to choose healthier foods I do use

it sometimes for people who are

struggling with food addictions it's

available in generic form which is much

less expensive and it's a reasonable

medication I think for treating food

addictions but as far as a powerful

weight loss medication it's not really

that great bell Veeck is kind of a newer

version of fen fleur amine which was

part of the fen phen it was actually the

bad part of the fen phen that they had

to pull off the market and it caused the

cardiac problems that could be fatal and

this supposedly doesn't have that same

side effect it's been out for a while we

really haven't seen it but it also

doesn't work that great I really have

not seen a lot of success from Bell

Veeck every now and then I'll see

someone who's on it and it's done well

but it's not off patent it is

fairly expensive and really the weight

loss is fairly modest without question

the most effective weight loss drug we

have is six Enda and I think this is

where we're gonna see some promise in

the future there's some some relatives

of six Enda which actually have shown

potentially even more weight loss these

are all diabetes drugs and they're being

repurposed and resold as weight-loss

drugs because they do cause weight loss

saxena is really the same drug as

Victoza just dosed at a higher level

i've seen some really great weight loss

like 30 40 pounds or even more on six

anda the big problem with six anda is

two things number one it's a daily

injection so you have to inject yourself

every single day there's some other

versions that are probably going to come

out as weight loss medications in the

next I don't know with two three five

years where it's a weekly injection

which i think is a lot more palatable

for people but you know a daily

injection I think is a tough thing to

sign up for the other and the real

substantial downside to six anda is that

it's extremely expensive it's covered by

very few insurance policies we need to

we need to lower the prices extend it

and get it covered by more policies

because it really is a very powerful set

point lowering drug with not a ton of

side effects it's prescribed it a lot

and I'm really happy with the results

but it is very expensive you don't have

insurance coverage which most people

don't with a coupon you can probably get

it between 700 to 800 dollars a month

and I think the important thing to

remember about weight loss medications

is these are setpoint lowering

treatments so you're if you're losing 40

pounds if you're going from 240 pounds

down to 200 pounds and losing that

weight from saying six Enda that what

that drug is doing is essentially

lowering the setpoint that your body

tries to regulate in terms of your

weight which is great this is how you

lose weight permanently the problem is

is you have to continue the medication

if you're going to maintain the weight

loss so if you go on six end or

phentermine or any of these medications

and you

wait and you're super happy the second

you stop the medication the weights

gonna start coming back the setpoint

goes back up and this whole process

reverses and we see weight gain it's

almost inevitable when we stop these

medications so if you are exploring

medications for weight loss I think it's

either critical that you pair them with

nutrition and exercise and really when I

see patients medications are what we use

to kind of add a little bit extra to the

nutritional plan and the exercise plan

that we've implemented and potentially

the bariatric surgery plan I actually

use a lot of weight loss medications

after bariatric surgery but you have to

make sure you understand you're going to

be on these for a long period of time so

if you have want more info about this

you can check out nutrition course

number two or nutrition course number

three or nutrition course number one on

dr. Wyner comm or you can check out my

book how weight loss surgery really

works again chapter four covers this in

a reasonable amount of detail and also

my book a pound of cure thanks