Weight loss is not all its cracked up to be.

Want to lose those extra kilos or pounds? Well think again. Whilst being overweight in the past is more likely to cause health problems in the future, carrying a little bit of “reserve nutrition” as you get older is probably better for you. All health experts talk about your BMI or Body Mass index – it basically measures your body fat but sometimes it is not that accurate.

A professional rugby player may have a high BMI around 33 or more (which is obese!) but that’s not necessarily bad because they are likely to have more muscle and less body fat – and they could probably run 100m in 11 to 12 seconds!

This is not the case though for most people and yes, a BMI around 30 or more is certainly asking a lot more from your body systems and organs, as you get older.

What is the ideal BMI?

Recent Australian research shows that for people over 65 years of age, the lowest risk of death was with a BMI of around 27-28 which is considered overweight by the World Health Organisation Guidelines. In fact, malnutrition and frailty in older people is also a big problem where a BMI of less than 23 is now considered underweight!

Interestingly, the QLD government also now recommends a healthy BMI range between 24 to 30 for the elderly.

Still it is not that simple. It is all about what you can do (or how active you are), what you eat (more food pyramids!), and what damage (like diabetes and arthritis) has been done to your body along the way. That is, if you weight history shows you to be overweight or obese (BMI > 30) for a long time (20 years or more), and you smoked, and you drank too much alcohol, and you didn’t exercise enough, then there is every chance some major damage will prevent you from being healthy and active in the future – especially if you carry too much weight today.

So how do you lose that weight?

Everyone knows about a weight loss remedy or has heard about one from someone else. However, when it comes to medicines that are more likely to work for you there remain only a few prescription medicines that do have the “good weight” of evidence behind them.

These include the following medicines;

1 . Phentermine (DuromineR or MetermineR)

  • acts on the brain to slow down your appetite
  • should only be used for 12 weeks or so (but can be used longer under special conditions)
  • could lose around 5 to 10% of body weight with the right diet
  • can cause side-effects like fast heartbeat, high blood pressure, insomnia (broken sleep), diarrhoea or constipation, and dry mouth

2. Orlistat (XenicalR)

  • Reduces how much fat gets into your body by up to 30%
  • May lose up to 10 kg in 12 months WITH low calorie (or Joule) diet
  • May slow down diabetes by 40%
  • Relatively safe but may reduce vitamins A, D, E, and K in your body
  • May cause kidney stones (rarely) but WILL cause diarrhoea if you eat too many fatty foods with this medicine.

3. Liraglutide (SaxendaR) Injection

  • Slows down appetite and stomach emptying (less likely to over eat)
  • Lowers blood sugar but must be injected every day!
  • Can cause nausea, vomiting, and diarrhoea – usually only in the beginning until your body adjusts to the drug.
  • May cause gall stones (rarely) and inflammation of pancreas (very rarely)
  • May reduce weight by 8 to 10% over 12 months
  • May help reduce heart and blood pressure problems in the future.

Of course, these medicines work much better with a good diet, regular exercise, less alcohol and no smoking!

Some people with diabetes may also have to adjust their medicines a little, especially if they are eating less food and exercising more because their blood sugar may go too low – if in doubt check with your doctor or pharmacist (and dietitian).

One thing is for sure, don’t forget your weight history, try to work on the here and now, so that you can look after yourself in the future.

Emmanuel Pippos, Consultant Pharmacist

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