What is the Strongest Weight Loss Prescription Pill?

Diet and exercise can help you lose weight. However, many people need more support. For some, this comes in the form of prescription weight-loss medication.

With so many options available, choosing the right medication can be daunting. Which one fits your lifestyle? What results can you expect? And how do they actually work?

In this blog, we’ve compiled all the information you need on the best prescription weight-loss drugs in Canada, from oral medications to injectables. 

What are the effects of the strongest pill medications?

In Canada, two prescription pills are approved for weight loss and obesity management. Here’s how they stack up against one another.

Contrave

Contrave is a combination of two medications: Naltrexone, which is used to treat alcohol and opiate addiction, and Bupropion, an antidepressant. Together, these drugs work on the reward centre of your brain to reduce cravings and curb your appetite. 

Contrave is taken as a pill, with the dose gradually increasing in strength. That means you begin by taking one tablet once a day and gradually increase your dosage up to a maximum of two tablets twice a day over four weeks.

In one study of 793 participants, on average, 66% of participants who took Contrave along with exercise and dietary changes lost more than 5% of their body weight. A further 41% of the group dropped more than 10% of their initial weight, while 29% shed more than 15% of their starting weight.

Given these results, Contrave is only approved for weight loss, as primary care providers would not want patients to lose weight unnecessarily and suffer side effects like nausea, vomiting, dizziness, dry mouth, constipation, and headaches. It’s only approved for weight loss in adults with a Body Mass Index (BMI) over 30 or a BMI of 27 and at least one weight-related condition. 

Orlistat (Xenical)

Orlistat is a prescription weight-loss medication sold under the brand name Xenical. It works by preventing certain enzymes in your body from breaking down dietary fat. This stops your body from absorbing the fat in your food, leaving it to pass undigested through your system during bowel movements.

Patients take one 120 mg tablet of Orlistat three times a day, each with or within an hour of a fat-containing meal. Typically, patients lose at least 5% of body weight within six months, or the medication is discontinued.

Despite its potential for results, there are a couple of things to keep in mind when it comes to taking Orlistat. The first is that while Orlistat prevents your body from absorbing fat, it doesn’t stop your body from taking in calories. So, if you eat a diet that’s high in refined carbohydrates like bread, pasta and rice, you will continue gaining weight. 

Similarly, because Orlistat eliminates fat from your body, it reduces your ability to absorb several fat-soluble vitamins. This makes it a good idea to take a daily multivitamin while you’re on this medication. Side effects for Orlistat include oily spotting on underwear, gas with oily spotting, loose stool, or difficulty controlling bowel movements. 

Like Contrave, Orlistat is approved for weight loss in adults with a BMI over 30 or those with a BMI of 27 and at least one weight-related condition.

What about injectable weight-loss medications?

Right now, you can’t discuss weight-loss medications without mentioning Ozempic. However, while Ozempic may be known as a weight-loss drug, it’s not officially approved for this use. Ozempic is authorized for treating type 2 diabetes.

Instead, Health Canada has approved the following injectables for weight loss:

Wegovy

Wegovy contains semaglutide, the same medication that’s effective for weight loss in Ozempic. Known as GLP-1 agonists, this class of medication prompts your pancreas to produce more insulin, helping to lower your blood sugar. In addition, it slows your digestion and signals fullness to your brain. This leaves you feeling fuller sooner and longer than normal and reduces your appetite.

Study results show that these effects caused participants to lose an average of almost 6% of their starting body weight after three months. After 6 months on the drug, this climbed to an average loss of almost 11% of their starting body weight.

Semaglutide’s effects are long-lasting, so Wegovy only has to be taken once a week. It comes in a prefilled pen, which you self-inject into a fattier part of the body, such as the abdomen, thigh, or upper arm. In Canada, it’s approved for weight loss in adults with a BMI of 30 and above, or a BMI of 27, and at least one weight-related health condition. 

Saxenda (liraglutide)

The active ingredient in Saxenda is liraglutide, which is also a GLP-1 agonist, so it works in much the same way as semaglutide. In other words, it prompts your stomach to digest your food more slowly, signals fullness to your brain, and helps to lower your blood sugar. The end result is a reduction in appetite so you eat less.

After 56 weeks of using Saxenda, these effects caused 64% of patients to lose at least 5% of their starting body weight and one-third to lose more than 10%.

Saxenda is approved for weight loss in the same populations as Wegovy. However, it has one additional stipulation for those with a BMI of 27 and one weight-related comorbidity like hypertension, type 2 diabetes, mellitus, or dyslipdemia. 

In addition, Saxenda isn’t as long-lasting as Wegovy. So, instead of being injected once a week, it’s meant to be taken once a day via a prefilled, self-injectable pen.

Saxenda vs. Wegovy—what’s better?

Given their similarities, it’s natural to think that Saxenda and Wegovy are interchangeable. However, a study comparing them found a considerable difference in their effectiveness.

During a 68-week study, participants who received a weekly injection of 2.4 mg of Wegovy lost an average of 15.8% of their body weight. In contrast, those taking a daily injection lost an average of 6.4% of their body weight over the same time. 

It’s important to remember that Saxenda and Wegovy are fundamentally different medicines that will always be prescribed according to your unique health picture and goals, under the guidance of an experienced medical professional. 

Do you regain weight after taking weight loss pills?

While the effectiveness of different weight-loss medications varies, they all tend to have one thing in common: most people regain their weight when they stop taking them. Within a year of going off these medications, participants gained back an average of two thirds of the weight they’d lost. 

Not everyone had the same experience, however. In most cases, those who regain the quickest are those who lost the most — 20% or more of their total weight. In contrast, individuals who continued with interventions like exercise, consistent sleep, and dietary changes were better able to maintain their weight loss.

How to find the best weight loss medication for you

If losing weight feels hard, it’s because it is. Weight gain is influenced by so many different factors, from individual metabolism and genetics to environment and health. What works for one person won’t necessarily work for another. This makes it crucial to get personalized weight loss advice that’s tailored to you.

If you’re looking for support with weight loss, Maple is here for you. With Maple, you can book an appointment with a Canadian-licensed primary care provider or, depending on the province, a weight management specialist where and when it’s convenient for you. 

From there, your provider can assess your current health status, medical history and weight loss goals to determine if prescription weight-loss medication is right for you. If it is, they can provide a prescription at their discretion and send it to the pharmacy of your choice for pick up or delivery.

What’s more, you can connect virtually with Canadian-licensed primary care providers through Maple’s network 24/7/365. This allows you to adjust your dosage or discuss any side effects as they arise. 

Although they’re not for everyone, weight-loss medications may help some individuals with better health outcomes. However, while certain ones may have higher efficacy rates than others, this doesn’t always make them the best fit for you.

Weight loss solutions should always be individualized. If you’re looking for help losing weight with prescription medication, make sure you see a knowledgeable primary care provider who considers your individual needs and health profile.

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.