More and more weight loss researchers are recommending that Belviq and Qsymia become the second line anti-obesity treatments after diet and exercise fail people.

As much as I dislike pharmaceuticals, I think this is probably the right way to go for many people since no “natural drugs” work for this and diet and exercise are basically falsified theories of weight loss for 5-10% of the population.

These recommendations would replace the current default second line recommendations of Orlistat and bariatric surgery, which are relatively more ineffective and relatively more dangerous, respectively.

Meta-study notes two other promising off-label prescription drugs cocktails that are coming down the clinical trial pipeline, and barring heart-health issues, will eventually win weight-loss drug approval:

• Liraglutide (3mg/day) caused significant weight loss for subjects in a 1 year trial vs placebo (-6.11kg). It’s similar to Belviq and Qsymia’s long-term effectiveness. Downsides are that it’s an injectable and currently it’s only prescribed for diabetes. But maybe something to consider if you don’t like the prospect of taking SSRI-like Belviq or fen-phen-ish cocktails like Qsymia.
• Naltrexone (SR) 32 mg + Bupropion SR 360 mg/day is a, non-approved weight-loss cocktail of anti-addiction drug that tend to cause weight loss as as side effect. I’m generally skeptical of anti-depressants, companies re-patenting drugs to get extended market protection, and drugs where the best property of them is a side-effect. This seems like the most side-effect laden of all these options and is probably a bad idea for most people. Still, I expect it to roll out as an approved treatment in 2017 for people who don’t respond to Belviq/Qsymia. Seems like a good option for people who have enough problems in life that they welcome the additional anti-drinking, anti-smoking, anti-depressant side-effects of this cocktail.

In terms of effectiveness and taking into account things I’ve studied about weight loss before, I’d currently recommend trying something like this order of interventions if you have recalcitrant weight problems that don’t subside with regular diet and exercise alone:

1. Metformin
2. Belviq
3. Qsymia
4. Orlistat
5. Liraglutide
6. Naltrexone SR / Bupropion SR
7. Bariatric Surgery