How to lose weight

Do you have trouble losing weight? Or would you like to lose faster? You’ve come to the right place. Get ready for weight loss without hunger.

Our conventional ideas about weight loss – eat less, move more – require a lot of willpower. Counting calories, exercising for hours every day and trying to ignore your hunger? At DietDoctor, we believe that’s needless suffering, and likely a waste of your time and precious energy.

Eventually people often give up. An excessive focus on counting calories has certainly not done much to reverse our current obesity epidemic.¹ Fortunately there may be a better way.

The bottom line? Calories are not the only things that count in weight loss. Your weight is also hormonally regulated. If you reduce your hunger and the levels of your fat-storing hormone, insulin, you’ll likely have an easier time losing excess weight.²

Top 18 weight-loss tips

Are you ready? Here we go. Start at the top of the list (most important) and go down as far as you need. Click on any tip to read all about it. Perhaps you only need the first piece of advice?

1. Choose a low-carb diet
2. Eat when hungry
3. Eat real food
4. Eat only when hungry
5. Measure your progress wisely
6. Be persistent
7. Avoid fruit
8. Avoid beer
9. Avoid non-caloric sweeteners
10. Review any medications
11. Stress less, sleep more
12. Eat less of dairy products and nuts
13. Supplement vitamins and minerals
14. Use intermittent fasting
15. Exercise wisely
16. Achieve optimal ketosis
17. Get your hormones checked
18. Consider weight-loss pills (if desperate)

 
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2. Eat when hungry

Don’t be hungry. A common mistake when starting a low carb diet: reducing carb intake while still being afraid of fat.¹¹ Carbs and fat are the body’s two main energy sources, and it needs at least one of them.

Low carb AND low fat = starvation

Avoiding both carbs and fat can result in hunger, cravings, and fatigue. Sooner or later many people can’t stand it and give up. The solution can be to eat more natural fat until you feel satisfied. For example:

• Butter
• Full-fat cream
• Olive oil
• Meat (including the fat)
• Fatty fish
• Bacon
• Eggs
• Coconut oil, etc.

Top 10 ways to eat more fat

Always eat enough, so that you feel satisfied, especially in the beginning of the weight-loss process. Doing this on a low-carb diet means that the fat you eat will be burned as fuel by your body, as your levels of the fat-storing hormone insulin are lowered.¹²

You’ll become a fat-burning machine. You’ll be more likely to lose excess weight, often without hunger.¹³

Do you still fear saturated fat? You may want to reconsider that. The fear of saturated fat is based on theories that recent studies suggest are misguided and incorrect. ¹⁴

Butter, steak, and cream are fine foods. However, feel free to eat mostly unsaturated fat (e.g. olive oil, avocado, fatty fish) if you prefer. This could be called a Mediterranean low-carb diet and works great too.¹⁵

Eating when hungry also implies something else: if you’re not hungry, you probably don’t need to eat yet. When on a keto diet you can trust your feelings of hunger and satiety again. Feel free to eat as many — or as few — times per day as you feel is right for you.

Some people eat three times a day and occasionally snack in between (note that frequent snacking could mean that you’d benefit from adding protein or fat to your meals, to increase satiety). However, there’s some evidence that frequent snacking isn’t wise when trying to lose weight.¹⁶ Some people only eat once or twice a day and never snack. Whatever works for you. Just eat when you’re hungry.

Read more about why eating when hungry is smarter than counting calories

Learn more about fueling your body with fat

4. Eat only when hungry

On a low-carb diet you should aim to eat when hungry (see tip #2 above). And if you’re not hungry? Don’t eat. Frequently eating more food than you need to stay satisfied will slow down weight loss.²¹ This, in fact, is so important that it’s worth a section of its own.

Limit unnecessary snacking

Unnecessary snacking can be a problem on a keto diet too. Some things are easy to eat just because they’re tasty and readily available. Here are three common traps to watch out for on a keto or low-carb diet:²²

1. Dairy products such as cream and cheeses. They work well in cooking, as they satisfy. But problems arise when you’re munching a lot of cheese in front of the TV in the evening — without being hungry. Be careful with that. Another problem might be having lots of cream with dessert, when you’re actually already full and just keep eating because it tastes good. Another common culprit is loads of heavy cream in the coffee, many times per day.
2. Nuts. It’s very easy to eat until the nuts are gone, regardless of how full you are. A tip: According to science, salted nuts are harder to stop eating than unsalted nuts.²³ Salted nuts tempt you to more overeating. Good to know. Another tip: Avoid bringing the entire bag to the couch, preferably choose a small bowl instead. Personally, I often eat all the nuts in front of me, whether I’m hungry or not.
3. Low-carb baking. Even if you’re only using almond flour and sweeteners, snacking on baked goods and cookies usually provides additional eating when you’re not hungry — and yes, this will slow down weight loss.

Feel free to skip meals

Do you have to eat breakfast? Research has confirmed that the answer is no.²⁴ Don’t eat if you’re not hungry. And this goes for any meal.

On a strict keto diet the hunger and urge to eat tend to decrease a lot, especially if you have excess weight to lose.²⁵ Your body may be happily burning your fat stores, reducing the need to eat.

If this happens, be happy! Don’t fight it by eating food you don’t want. Instead, wait for the hunger to return before you eat again. This will save you both time and money, while speeding up your weight loss.

Some people fear that they will lose control if they don’t eat every three hours. The concern that this “urge to binge” will blow their diets completely leads them to obsessively snack all the time.

This constant snacking may be necessary in order to control the hunger and craving that may arise during a diet high in sugar and starchy carbs, but it’s usually unnecessary on a keto diet. Hunger will only slowly return and you should have plenty of time to prepare food or grab a snack.

Bottom line: To lose weight in a sustainable way, eat when you’re hungry – but only when you’re hungry. Forget the clock and listen to your body instead.

6. Be persistent

It usually takes years or decades to gain a lot of weight. Trying to lose it all as quickly as possible by starving yourself does not necessarily work well long term; instead it may be a recipe for “yo-yo dieting”.²⁸ To succeed, you need something that works long term.

In addition, you need to set realistic expectations for health and weight loss goals. You can read more in our detailed guide on realistic expectations.

What to aim for

It’s common to lose 2-6 pounds (1-3 kg) within the first week on a strict low-carb diet, and then on average about one pound (0.5 kg) per week as long as you have a lot of weight remaining to lose.²⁹ This translates into about 50 pounds (23 kilos) per year. However, weight loss doesn’t occur at this rate in everyone.

Every 5 pounds of fat loss roughly equals 1 inch lost around the waist (1 kilo = 1 cm).

Young males sometimes lose weight faster than this, perhaps twice as fast.³⁰ Post-menopausal women may lose at a slower pace.³¹ People on a very strict low-carb diet may lose weight quicker, as well as those who exercise a lot (a bonus).³² And if you have an enormous amount of excess weight to lose, you could start out much faster — although initially, some of the weight you lose will be due to water loss.

As you get closer to your ideal weight, the loss may slow down until you stabilize at a weight that your body feels is right. Very few people become underweight on a low-carb diet as long as they eat when hungry.

Initial stalls

Are you coming off a period of semi-starvation (which can occur with calorie-counting)? Focus on your waist circumference and health markers (see advice #4) at first, as it sometimes takes several weeks before weight loss is apparent.³³

Weight-loss plateaus

Expect weight-loss plateaus: months where nothing seems to happen on the scale. Everybody hits them.³⁴ Stay calm. Keep doing what you’re doing and eventually things should start happening again (if not, check out the other 17 tips).

More: Top 10 tips top break a weight loss stall

How to keep the weight off long term

Losing a lot of weight long term and keeping it off will likely not happen unless you change your habits forever. If you lose weight and then return to living exactly the way you did when you gained weight, don’t be surprised when the excess weight returns. It normally will.

Maintaining weight loss usually requires long-term change and patience. As tempting as it may be, don’t fall for one of these magical diet scams.

Forget quick fixes: If you lose some weight every month, eventually you may get rid of all your excess weight. That’s inevitable progress. That’s what you want.

PS: Long-term change is hardest in the beginning, especially during the first couple of weeks. It’s like quitting smoking. Once you develop new habits it becomes easier and easier every week. Eventually it may come naturally.

For inspiration and tips, check out some of our long-term weight maintenance success stories:

• Karen: Maintaining a 70-pound weight loss for five years
• How Melissa lost 100 pounds with a keto diet, and kept it off for 15 years
• Brian: Maintaining a 100-pound weight loss for seven years

How to lose weight faster

Keep reading!

8. Avoid drinking beer

Beer contains rapidly digested carbs that shut down fat burning. That may be why beer is sometimes referred to as “liquid bread.” There’s a good reason for the term “beer belly.”³⁸

Here are smarter (lower-carb) alcoholic options for losing weight:

• Wine (red or dry white)
• Dry champagne
• Hard liquor like whisky, cognac, vodka (avoid sweetened cocktails – try vodka, soda water, lime instead)

These drinks hardly contain any sugar or digestible carbohydrates so they’re better than beer. However, large amounts of alcohol might slow weight loss somewhat, so moderation is still a good idea.

Low‑carb alcohol –
the best and the worst

10. Review any medications

Many prescription drugs can stall your weight loss. Discuss any change in treatment with your doctor. Here are the three most common offenders:

• Insulin injections, especially at higher doses, are probably the worst obstacle for weight loss for many people.⁴³ There are three ways to reduce your need for insulin:
  A. Eat fewer carbs, which makes it easier to lose weight. The fewer carbs you eat the less insulin you need.⁴⁴ Remember to work closely with your healthcare provider to ensure you safely lower your doses.

  B. If this isn’t enough, treatment with metformin tablets (at a dose of 2–3 grams/day) can decrease the need for insulin (at least for people with type 2 diabetes).⁴⁵

  C. If this is not enough to get off insulin (again, for people with type 2 diabetes) discuss with your doctor if it is appropriate to try newer drugs like Victoza/Saxenda (liraglitude) or Byetta (exenatide). These reduce the need for insulin and may cause weight loss, but possible long-term side effects are still unknown.

  You can learn more in our guide on starting low-carb or keto with diabetes medications.

• Other diabetes medications, like insulin-releasing tablets (e.g. sulfonylureas), often lead to weight gain.⁴⁶ These include: Minodiab (glipizide), Euglucon (glibenclamide), and Daonil (glyburide). Tablets like Avandia, Actos, Starlix and NovoNorm also encourage weight gain. But not metformin. More on diabetes
• Cortisone as an oral drug is another common issue (e.g. prednisolone). Cortisone may cause weight gain in the long run, especially at higher doses (e.g. more than 5 mg prednisolone per day).⁴⁷ Unfortunately, cortisone is often an essential medication for those who are prescribed it, but the dose should be adjusted frequently in concert with your healthcare provider so you don’t take more than you need.

These other medications can also cause problems:

• Neuroleptics/antipsychotic drugs can often encourage weight gain, especially newer drugs like Zyprexa (olanzapine).
• Some antidepressant medications can cause weight gain, especially the older tricyclic antidepressants (TCAs) such as Tryptizol/Saroten (amitriptyline), and Anafranil (clomipramine); as well as newer drugs such as Remeron (mirtazapine).⁴⁸ Lithium (for manic-depressive disorder) often causes weight gain. The most common antidepressants known as SSRI’s, for example, Celexa (citalopram) and Zoloft (sertraline) do not appear to impact weight significantly.⁴⁹ More on depression
• Some contraceptives may contribute to a slight weight gain, primarily those that contain only progesterone and no estrogen, for example the mini-pill, the contraceptive injection, or a contraceptive implant.⁵⁰ More on fertility
• Blood pressure medication in the form of beta blockers may lead to weight gain in some individuals. These drugs include: Seloken, Lopressor (metoprolol), and Tenormin (atenolol). More on high blood pressure
• Epilepsy drugs may cause weight gain (e.g. carbamazepine and valproate).
• Allergy medications and antihistamines can interfere with weight loss, especially at high doses. Cortisone is even worse (see above). More on allergies
• Antibiotics may possibly lead to a temporary weight gain by disturbing the gut microbiota and increasing the amount of energy we absorb from food.⁵¹ This is still speculative for humans but it’s a reason not to use antibiotics unless you truly need it.

12. Eat less of dairy products and nuts

Can you eat as much as you like and still lose weight? This often works well with a low-carbohydrate diet, as appetite regulation often improves.⁵⁴

However, despite the fact that a low-carbohydrate diet generally makes it easier to eat just enough, there are foods classified as low carb which become a problem in larger quantities. If you find yourself having a hard time losing weight on a low carb diet, you could try to be more careful with:

• Dairy products (yogurt, cream, cheese)
• Nuts

Dairy products contain varying amounts of lactose (milk sugar), which could potentially slow down weight loss. Consequently, cutting back on dairy products may help accelerate weight loss.

This applies especially to dairy products typically lacking in fat, such as regular milk and various yogurts. But be careful with full-fat dairy such as cream and cheese all the same, as they are easy to overindulge in.

Exempt from all these dairy-product warnings is butter, which is almost pure fat. Generally speaking, butter may be consumed as desired – but pay attention to fullness cues if your goal is weight loss. If it is overconsumed, dietary fat will be burned for fuel instead of body fat.

Low-carb and dairy-free recipes

Nuts, the second food to watch, contain a fair amount of carbohydrate, and it’s very easy to unwittingly scarf down large quantities.⁵⁵ Cashew nuts are among the worst carb-wise – you’ll find that they contain around 20% carbohydrate by weight.

For someone following a strict keto diet with a 20 grams of carbs per day allowance, this means that consuming 100 grams of cashews (which happens in a flash!) will have filled their daily quota. Peanuts tend to be around 10-15% carbohydrate – not putting them in the clear either.

So, for those of you having trouble losing weight: use nuts sparingly. When in a situation where nuts are an absolute must, know that the most harmless ones carb-wise are macadamia nuts (usually around 5% carbs), or Brazil nuts (4%).

Low-carb nuts – the best and the worst

 

 

14. Use intermittent fasting

There are many things to consider before moving on to this tip #14, but don’t let this concern you. This is one of the most effective weapons available to lose weight. It may be perfect if you are stuck at a weight-loss plateau despite “doing everything right” – or to speed up your weight loss.⁵⁹

This weapon is called intermittent fasting. It means exactly what it sounds like: not eating during a specified time interval.

Recommended first option – 16:8

Probably the most popular option is fasting for 16 hours (including sleep), which is usually easy to do on a keto diet. It requires trading breakfast for a cup of coffee (or some other non-caloric fluid) and having lunch as the first meal of the day. Fasting from 8 pm to 12 noon – for example – equals 16 hours of fasting. Another option is to skip dinner: eat breakfast and lunch within 8 hours — for instance, 8 am to 2 pm — and then don’t eat again until 8 am the next morning.

There are many other versions of intermittent fasting, but this 16:8 method (16 hours of not eating with an 8-hour eating window) is the one we recommend as a first option. It’s often effective, generally easy to do and does not require counting calories.

You can do a 16:8 fast as often as you like. For example twice a week, on weekdays only, or every single day. The more often you do it, the more effective it may be.⁶⁰

In fact, on a keto diet some people spontaneously fall into this habit, as their appetite is reduced (see weight loss tip #4, eat only when hungry).

Other kinds of intermittent fasting

There are many other options. Basically, the longer periods are harder to do but could potentially be more effective. Here are two more common options:

• Fasting for 24 hours (often dinner to dinner) once or twice a week. This can be effective and easy to do for some people, especially on a keto diet, which usually reduces appetite.
• The 5:2 diet. Eat as much as you need to feel satisfied 5 days of the week and then eat calorie-restricted on two days (500 calories per day for women, 600 calories for men). This requires calorie counting and more planning, but some people still find they enjoy it.

What about eating when hungry?

Doesn’t advice on intermittent fasting contradict the advice to eat when hungry? Yes it does, somewhat.

We recommend eating when hungry as a first option, and we recommend always eating until you feel satisfied at meals. But if this is not effective enough, then intermittent fasting is a very powerful addition. Remember – and this is crucial – that between fasting periods you’re still supposed to eat until satisfied.

Intermittent fasting is not the same thing as obsessively counting calories and starving yourself 24-7. Starving yourself may be a recipe for misery and failure.

Intermittent fasting is about eating all that your body needs, while still allowing it to sometimes briefly rest from constant feeding.

What’s acceptable to drink during fasts?

During a fast you can’t eat, but you should definitely drink. Water is the drink of choice, but coffee and tea are also great options. During longer fasts it can be wise to add some salt too, or drink bouillon.⁶¹

Anything you drink should ideally be zero calories. But it may be acceptable to modify this by adding a small amount of milk or cream in your coffee or tea – if you absolutely need it to enjoy your drink.

What to eat between fasts

So what should you eat when you are not fasting? Well, if your goal is to lose weight, we suggest following all the tips above, including eating a low-carb diet. Combining this with intermittent fasting is a great combination.

On a low-carb diet your hunger is reduced and it’s much easier to do a period of fasting. Also, your fat burning is already increased – so when fasting you’ll more easily burn plenty of fat.⁶²

So, while on a low-carb diet the fasting periods may become both easier to do and more effective. 1 + 1 equals 3.

Who should not do intermittent fasting

Intermittent fasting can be a great idea, but not everyone should do it:

• If you have a history of disordered eating then intermittent fasting may not be right for you. We recommend consulting with your physician before trying intermittent fasting.
• If you are stressed out or sleep deprived, then take care of that problem first (see weight loss tip #11) or fasting may be too stressful for your body.
• If you are on any medication – especially insulin – the doses may need to be adjusted when fasting. Discuss this with your doctor first.
• Growing children, pregnant women and breastfeeding women should not do longer fasting periods, as they have an increased nutrient needs. We recommend eating when hungry and using the 14 tips above if you need to lose weight.

More

Intermittent fasting for beginners

Guide to time restricted eating

Video

For more on fasting check out our material with our top fasting expert, Dr. Jason Fung:

16. Achieve optimal ketosis

Warning: Not recommended for people with type 1 diabetes, see below.

We’ve now arrived at tip number 16. If you’re still having trouble losing weight, despite following the 15 pieces of advice listed above, it might be a good idea to bring out a controversial option: optimal ketosis. Why is it controversial? For most people, “low” or “higher” ketone levels don’t make a difference for health and weight loss, and in general we do not recommend shooting for a specific ketone level.⁶⁹ However, for some people stalling at weight plateaus while on a low carb diet, trying to raise ketone levels may be of benefit.

So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy.⁷⁰

This tends to cause you to want to consume fewer calories than you expend – without hunger – and lose weight.⁷¹ Several of the tips mentioned above are about fine-tuning your diet to better this effect.

Ketosis

Ketosis is a state where the body is burning fat at an extremely high rate. Even the brain runs on fat, via ketone bodies. These are energy molecules in the blood (like blood sugar) which become fuel for our brains after being converted from fat by the liver.⁷²

To encourage ketone production, the amount of insulin in your bloodstream must be low. The lower your insulin, the higher your ketone production. And when you have a well-controlled, sufficiently large amount of ketones in your blood, it’s basically proof that your insulin is very low – and therefore, that you’re enjoying the maximum effect of your low-carbohydrate diet.⁷³

Measuring ketones

Today, there are reasonably-priced gadgets available for measuring ketone levels at home. One needle prick of the finger, and in just a few seconds you’ll know your blood ketone level.

Blood ketones are best measured on a fasted stomach in the morning (before breakfast, that is). Here are a few pointers on how to interpret the result:

• Below 0.5 mmol/L is not considered “ketosis”. At this level, you’re likely not at maximum fat-burning.⁷⁴
• Between 0.5-3.0 mmol/L is nutritional ketosis. This is where you see the beneficial effects on weight and metabolic health. For most people, it won’t matter where in this range you fall.
• Around 1.5 – 3 mmol/L is what’s called “optimal ketosis” for some. If you have hit a weight loss stall without a clear reason, one possible intervention is to increase your ketone levels. Although there is no scientific support for this intervention, rare cases may see benefit.⁷⁵
• Numbers over 3 mmol/L aren’t necessary. That is, they will achieve neither better nor worse results than being at the 0.5-3 mmol/L level.⁷⁶ Higher numbers can also sometimes mean that you’re not getting enough food. For people with type 1 diabetes, this can be caused by a severe lack of insulin (see below).

Ketones in urine

Ketone levels can also be measured in a more old-fashioned way, with urine test sticks (sold prescription-free in pharmacies or on Amazon⁷⁷). Ketone sticks give less reliable results for several reasons, and the above recommendations can’t be straightforwardly applied to them. They are, however, much cheaper.

My personal experience

Feel free to read my accounts of a two-month personal trial:

1. Experiment: Optimal ketosis for weight loss and increased performance
2. Four weeks of strict keto and ketone monitoring
3. Final report: Two months of strict keto and ketone monitoring

Although I was quite happy with my weight before these trials, they resulted in a further loss of 4.5 kg (10 pounds) and 7 cm (3 inches) around my waist – without additional exercise or even the slightest resemblance of hunger.

How to achieve optimal ketosis

Many who firmly believe they are eating a strict low-carb diet are surprised when they measure their blood ketones. They may be at around only 0.2 or 0.4. Why?

First, you should make sure you are avoiding all obvious sources of carbohydrate (sweets, bread, spaghetti, rice, potatoes). Next, check for “hidden carbs” in salad dressings, dips, and from other sources like alcohol.

You may consider adding intermittent fasting or exercise to your routine (see tips #14 and #15 above).

Sometimes adding MCT oil to your coffee or tea can help increase your ketone levels which may or may not resolve your stall. It may not be “magic” for everyone, but for some it may just do the trick.

Finally, make sure you are eating adequate amounts of protein. A keto diet is not meant to be a very high protein diet. We recommend 1.2 to 1.7 grams per kg of reference body weight per day.⁷⁸ Check out our target protein ranges to find out how much protein you should be aiming for each day.

Greater than 2 grams per kg of reference body weight may be an example excessive protein per day if you are trying to achieve higher ketone levels.

Less than 0.8g/kg/day is probably too low, as it’s below the RDA.

If it doesn’t work

Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be fairly certain that too many carbs are not part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next two tips in this series might help you.

Try it

Order a ketone meter online and start measuring. There are a few different models. The most popular one is probably the Precision Xtra ketone meter.⁷⁹ Unfortunately these meters are all quite expensive to use, as the test strips can cost about $5 per test. However, a new company, Keto-Mojo, offers a meter with test strips that are only $0.99 each.

Here’s a complete package⁸⁰ with everything you need to check your blood ketone levels.

More

Learn much more about ketogenic diets and ketosis:

A quick guide to ketogenic diets

Watch my video interview with the American doctor Peter Attia, on a strictly ketogenic low-carb diet: Very Low Carb Performance

A word of warning

If you have type 1 diabetes, you should not follow the above advice on optimal ketosis – it may be risky. If you have ketones in your blood at all, you must be sure that your blood sugar levels are normal and you are getting adequate insulin. If they are, you’re in normal ketosis – just like the ketosis of non-diabetic people who stick to a strict low-carb diet.

High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to contact your healthcare provider immediately or have someone take you to the hospital to be checked out. Coveting really high blood ketones for weight control is not worth the risk for people with type 1 diabetes.

18. Consider weight-loss pills (if desperate)

It sounds like a dream. Keep living like you already do, take a daily pill, and effortlessly lose your excess weight. This is why weight-loss pills are a billion dollar industry.

So do they work? Yes, somewhat. But they’re not very effective.

There are many drugs that result in a modest weight loss (a few pounds on average), often at the expense of significant side effects.

Prescription-free supplements

The internet is full of claims of magic supplements that can make you thin. Unfortunately, the only thing they’ll make thin is your wallet. This is true even if they were once mentioned on Dr. Oz – you know that’s an entertainment show, right?

Any prescription-free supplements for sale that are not dangerous or illegal are likely to have a small or negligible effect on your weight.

This is true even for the vitamin supplements mentioned in advice #13 – the effect is definitely small, but in that case it’s also safe – maybe even healthy – and also dirt cheap, making it a potentially smart bonus (note that we sell no supplements whatsoever and make no money from this piece of advice).

There are also prescription free “carb blockers” out there, that are supposed to stop the body from absorbing carbs we eat. The effects tend to be relatively tiny though, even in studies funded by the companies selling the products.⁸⁹ It’s definitely more effective to not eat the carbs in the first place (it’s also free).

Older appetite suppressants

In the US, it’s still possible to get amphetamine-like appetite suppressants prescribed for short-term use (weeks). As they are only for short-term use they are not used for long-term weight control. These drugs are not approved in the EU.

These drugs have side effects like insomnia, heart palpitations, and elevated blood pressure. It’s also possible to become addicted to them, and thus they require a special controlled-substance prescription. Examples include:

• Adipex-P or Suprenza (phentermine)
• Bondril (phendiametrazine)
• Didrex (benzphetamine)

The effect of these drugs is decidedly modest and short term, and it’s not clear they outweig their risks. We do not recommend them.

The “oily discharge” pill

Let’s move on to another older drug, Xenical (orlistat), lately for sale prescription-free as “Alli” and with a falling popularity.

This drug prevents the body from digesting fat in the intestines. Instead it just passes through you and ends up in the toilet — or (worst case) in your pants.

Side effects include stomach cramping, gas, leaking oily stool and being unable to control bowel movements. And finally the so called “oily discharge” that can result when people think they are just passing some gas.

This pill is not compatible with eating fat. Thus it’s not compatible with a low-carb diet. 
You may want to forget about this drug. Many doctors already have.

The stupid pill

Is there a worse option than Xenical/Alli? One candidate is called Qsymia.

Qsymia is available in the US, but it got rejected in Europe (where the side effects were judged worse than the benefits). I prefer to label this drug the “stupid pill”.

Qsymia combines a tiny amount of the old phentermine (see Appetite Suppressants above) with a small dose of topiramate, an anti-seizure drug.

The problem? Common side effects of topiramate include drowsiness, fatigue, depression, attention disturbance, memory impairment, cognitive disorder, impaired psychomotor skills (i.e. becoming clumsy), lethargy, balance disorder, sedation and gait abnormality (i.e. walking like you’re drunk).

Basically, this drug slows down your brain, like alcohol or sedatives. Are you really going to do that to lose a few pounds, that you’ll regain once you stop taking the drug?

The “meh” pills

Two more weight-control drugs were approved in the US in 2012 and are now available, Belviq and Contrave.

Belvic has been rejected in Europe because of safety concerns. Contrave was recently approved (under the name Mysimba).

These two drugs work on different receptors in the brain to control appetite. The effect is modest – 6 to 8 pounds (2.7 to 3.6 kg) lost in a year, with partial regain after that.

There are ongoing safety concerns with both drugs and a definite risk of side effects (for Contrave) like nausea, constipation, headache, risk of suicidal thoughts and seizures.

It seems like these modest benefits do not necessarily outweigh the risk of side effects.

The reigning champion

And then there is only one more approved weight loss drug left. Fortunately this one actually shows some promise and can speed up weight loss significantly.

This drug is an injected variant of a satiety hormone called GLP-1. It slows down how quickly the stomach empties and tells the brain that you don’t need to eat yet – not a bad idea for losing weight. As a bonus this drug works fine while one is on the keto diet and it works even better with intermittent fasting – for a rapid weight loss with no hunger.

This drug was initially used to control blood sugar in type 2 diabetes – under the brand name Victoza – where it has the nice side effect of significant weight loss.⁹⁰

Testing on people with obesity (without diabetes) shows that at higher doses the drug is fairly effective as a pure weight loss treatment, with patients losing on average 12.3 pounds (5.6 kilos) more than a placebo group after one year.⁹¹

This drug has recently been approved in both the US and in Europe for weight loss, under the name Saxenda. There are many other similar GLP-1 drugs for treating diabetes type 2, but none of them have been carefully tested or approved for treating obesity yet.

Saxenda is already available at the fantastic cost of about $1,000 per month.

In both the US and in Europe another option is Victoza, which is the exact same drug at half the dose and half the price. At this lower dose the resulting weight loss is about 75% of the weight loss when one is on Saxenda. Victoza is approved only for treating type 2 diabetes.⁹²

The main side effect of Saxenda/Victoza is what happens if the satiety effect becomes too strong: nausea and vomiting. This is quite common when starting out, so it’s necessary to start with a low dose and then slowly increase it as the body adapts to the medication.

The bonus

If you have type 2 diabetes there is another diabetes drug that can result in noticeable weight loss: the “low-carb in a pill” drug Farxiga (called Forxiga in Europe). Unfortunately, this pill has an increased risk of ketoacidosis, probably especially for people on strict low-carb or keto diets, and it’s not recommended to take this drug while on a strict low-carb diet.⁹³

The bottom line

There is no pill that easily makes people thin. These drugs all have side effects and none are very effective.

The only possible exception is Saxenda – and this is a daily injection, not a pill.

The downside to Saxenda is the very high price – insurance may only cover part of it – and the nausea that people often experience on it.

It’s also clear from my own and other people’s experience treating patients with it that it does not work well for everyone. Some people experience only minimal weight loss. Other people lose a lot more than the additional 12 pounds lost in a recent study – this is only an average.

Finally, Saxenda only works as long as you use it. Once you stop, the weight tends to return. So is losing about 12 pounds worth $1,000 per month and the risk of nausea? Only you can decide.

Most people who want to lose weight have more than 12 pounds to lose. That’s why even the best weight loss drug in the world can only be an optional complement to other treatment. That’s why this piece of advice is number 18 out of 18. It may be a helpful addition for some people, but the advice higher on the list is what can make the biggest difference, by far.

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