Did you know that there are multiple medications for weight loss? But how do we determine which medication is best for which patient? Looking at my patient population, about one and six patients have the problem of appetite control, the rest have other problems. Those problems include poor satiety, dis-inhibition, hedonic eating, and stress eating. Lets define these:

1. Appetite related – feeling hungry all the time
2. Poor satiety – once you start eating you do not feel full
3. Dis-inhibition – the inability to stop oneself from eating
4. Hedonic eating – gaining pleasure from eating
5. Stress eating – eating to help reduce stress

As you can see, there are many different reasons why a person may eat that does not involve feeling hungry.

The oldest and probably most effective medication for appetite suppression is phentermine but it does not seem to work as well in the other four reasons listed above that someone may overeat other than appetite related. We may need something like a GLP-1 Receptor Agonist, Bupropion with Naltrexone, Topiramate, or others.

So, why do certain medications work for appetite and others for satiety, rewards, and stress? It has to do with which neurons in the brain that the medications target. All the medications listed above seem to target the hypothalamus but in different areas. Some target the POMC/CART pathways, others block the GABA pathway, and others target the NPY/AgRP pathways. Here is a chart that shows some of the more complicated mechanisms.

So, if you are struggling with weight gain or the inability to lose weight, we can help! I specialize in this and my goal is to figure out the underlying causes and lead you down the correct path. One weight loss medication is not good for all. Give us a call today at  to set up an initial evaluation.

Seth Jarrell, MD
American Board of Obesity Medicine Diplomat