How to lose weight

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 hunger and fat-storing hormones 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 or high satiety diet
2. Eat when hungry
3. Eat real food
4. Eat only when hungry
5. Measure your progress wisely
6. Be persistent
7. Avoid overeating fruit
8. Avoid beer
9. Avoid non-caloric sweeteners
10. Review any medications
11. Stress less, sleep more
12. Eat less dairy products and nuts
13. Supplement vitamins and minerals
14. Use intermittent fasting
15. Exercise wisely
16. Achieve higher ketone levels
17. Get your hormones checked
18. Consider weight loss medications

 
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2. Eat when hungry

Eating when hungry sounds simple: if you’re not hungry, you probably don’t need to eat yet.

When on a low-carb or keto diet you can trust your feelings of hunger and satiety again — something many people following a low-fat or standard American diet cannot do.¹¹ 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, fibrous veggies, or extra fat calories to your meals, to increase satiety). However, there’s some evidence that frequent snacking may not be wise when trying to lose weight.¹² Some people only eat once or twice a day and never snack. Whatever works for you. Just eat when you’re hungry, and don’t eat when you aren’t.

It also helps that low-carb diets and higher protein diets — at least 20% of daily calories — tend to reduce hunger.

Studies demonstrate that people eating a very low-carb, ketogenic diet reduce their feelings of hunger and the amount of food they eat.¹³

Multiple other studies demonstrate that adding protein to your diet markedly reduces hunger and food intake.¹⁴

Our suggestion? Try a low-carb, higher protein approach and see what happens to your hunger levels.¹⁵

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

4. Eat only when hungry

When eating low carb or higher satiety foods 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 low-carb 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 low-carb or keto 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 – choose a small bowl instead.
3. Low-carb baking. Even if you’re only using almond flour and sweeteners, snacking on baked goods and cookies usually represents 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 strict low-carb or higher satiety diets the hunger and urge to eat tend to decrease significantly.²⁵ 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 low-carb 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 in the long term; instead it may be a recipe for “yo-yo dieting”.²⁹

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 or high satiety 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.³⁰ This translates into about 50 pounds (23 kilos) per year. However, weight loss doesn’t occur at this rate in everyone.

Young males sometimes lose weight faster than this.³¹ Post-menopausal women may lose at a slower pace.³² People on a very strict low-carb diet may lose weight quicker, as well as those who exercise a lot (a bonus).³³ And the more weight you vae to lose, the faster you can start to lose it— 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 or higher satiety 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 tip #4) at first, as it sometimes takes several weeks before weight loss is apparent.³⁴

Weight loss plateaus

Expect weight loss plateaus: months where nothing seems to happen on the scale. Everybody hits them.³⁵ 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.

But that doesn’t mean that the diet you used to initially lose excess weight is the only diet that will work for you. Clinical experience suggests that someone may do great at first with a ketogenic diet, but then may continue long-term success with a moderate carb higher satiety diet. The key is to keep an open mind and be willing to adjust along the way.

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.”³⁹

Here are smarter (lower-carb) alcoholic options when trying to lose 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, so moderation is still a good idea. ⁴⁰

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 with diabetes.⁴⁵ 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.⁴⁶ Remember to work closely with your healthcare provider to ensure you safely lower your doses.

  B. If this isn’t enough, treatment with metformin (an insulin sensitizing drug) can decrease the need for insulin (at least for people with type 2 diabetes).⁴⁷

  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 a drug in one of the newer classes like the GLP-1 analogues or DPP-4 inhibitors. There are many different options within these two categories; what you need to know is the drugs in these classes reduce the need for insulin and may also cause weight loss by other mechanisms — beyond just the effect of using less insulin.

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

• Other diabetes medications, like drugs that stimulate the secretion of insulin by the pancreas (e.g. sulfonylureas), often lead to weight gain.⁴⁸ These include: Amaryl (glimepiride), Glucotrol/Minodiab (glipizide), Euglucon (glibenclamide), and Daonil (glyburide). Additional diabetes medications like Actos (pioglitazone), Starlix (nateglinide) and Prandin/NovoNorm (repaglinide) also encourage weight gain. But not metformin. More on diabetes
• Cortisone and other glucocorticoids (e.g. prednisone, prednisolone, dexamethasone) are also common offenders. These drugs may cause weight gain in the long run, especially at higher doses (e.g. more than 5 mg prednisolone per day).⁴⁹ Unfortunately, a medication like cortisone is often essential 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 Elavil/Tryptizol/Saroten (amitriptyline), and Anafranil (clomipramine); as well as newer drugs such as Remeron (mirtazapine).⁵⁰ Lithium (for bipolar disorder) often causes weight gain. The most commonly prescribed antidepressants, in a class known as SSRI’s, generally have less of an impact on weight.⁵¹ 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.⁵² More on fertility
• Blood pressure medication in the form of beta blockers may lead to weight gain in some individuals. This class includes: Seloken/Lopressor (metoprolol), Tenormin (atenolol), and many others. 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.⁵³ This is still speculative for humans but it’s a reason to not use antibiotics unless you truly need them.

12. Eat less dairy products and nuts

Can you eat as much as you like and still lose weight? This often works well with a low-carbohydrate or higher satiety diet, as appetite regulation often improves.⁵⁷

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 are lower satiety foods and may become a problem in larger quantities. If you find yourself having a hard time losing weight on a low-carb diet, you could try shifting to a higher satiety diet and reducing:

• High fat dairy products (yogurt, cream, cheese)
• Nuts

High fat dairy products contain varying amounts of lactose (milk sugar) and lots of calories from fat — both of which could slow down weight loss when over-consumed. Consequently, cutting back on high fat dairy products may help accelerate weight loss.

Remember that, gram for gram, fat has twice the calories of carbs or protein; therefore, high-fat, highly palatable foods can deliver a huge calorie load before you know it.⁵⁸

When it comes to butter, you don’t need to worry about extra carbs, as butter is almost pure fat. But, like any other source of fat, if butter is over-consumed, the calories can add up and your dietary fat will likely 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 in addition to a significant amount of calories from fat, and it’s very easy to unwittingly scarf down large quantities.⁵⁹ That’s why nuts are a low satiety per calorie food.

The high calorie load delivered by handfuls of nuts can thwart weight loss. If you are trying to follow a strict ketogenic diet, with a 20 grams of carbs per day allowance, you should also note that cashew nuts are among the worst carb-wise – you’ll find that they contain around 20% carbohydrate by weight.

This means that consuming 100 grams of cashews (which happens in a flash!) will fill your 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. And for those of you on a strict keto diet, 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 tip #14, but don’t let this deter you. Intermittent fasting can be a powerful tool when trying 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.⁶⁴

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

Although it’s possible that doing it more frequently may improve your results, long-term studies are lacking.⁶⁵ Therefore, we simply don’t know if frequent fasting will decrease resting metabolic rate in a similar manner to continuous caloric restriction, making weight loss and maintenance more difficult in the long run.

Also, clinical experience suggests that some people feel the urge to overeat calories during their eating window when they first try intermittent fasting. If this is the case, it may not be the right time to try IF. Instead, you may benefit from focusing on higher satiety eating first, so that you have less hunger and feel less of an urge to overeat during your eating window.

Other kinds of intermittent fasting

There are many other options. Basically, the longer periods may be harder to do, but they can certainly be 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. You can learn more about eating one meal a day (OMAD) in our evidence-based guide.
• 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 can be a useful tool in your tool kit. 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.⁶⁶

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 or higher satiety diet. Pairing either of these with intermittent fasting is a great combination.

On a low-carb diet, hunger is typically reduced, making it much easier to fast. Also, glycogen stores in the liver should be lower while eating low carb, meaning that fasting may flip the metabolic switch to fat burning mode earlier than if not on a carb-restricted diet. This may be one of the mechanisms that enhances weight loss.⁶⁷

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 increased nutrient needs. We recommend eating when hungry and using the other tips in this guide if weight loss is needed.

More

Intermittent fasting for beginners

Guide to time restricted eating

16. Achieve higher ketone levels

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: higher ketone levels (this advice applies only to people following a ketogenic diet). 

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.⁷⁴ 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 release their stored energy and shrink.⁷⁵

This tends to cause you to want to consume fewer calories than you expend – without hunger – and lose weight.⁷⁶ Several of the tips mentioned earlier are about fine-tuning your diet to better this effect.

Ketosis

Ketosis is a state in which the body is efficiently burning fat. Even the brain runs on fat, in the form of 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.⁷⁷

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.⁷⁸

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.

Here are a few pointers on how to interpret blood ketone results:

• Below 0.5 mmol/L is not considered “ketosis”. At this level, you’re likely not at maximum fat-burning. However, some controversy exists for this cut off level as few head-to-head trials exist comparing low levels of ketone production. Some studies have shown benefit of a ketogenic diet with ketone levels as low as 0.3mmol/L.⁷⁹
• Between 0.5-3.0 mmol/L is nutritional ketosis. This is where you are likely to 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 the higher end of nutritional ketosis. If you are following a ketogenic diet to treat a neurological or mental health issue, you may be better off at this higher ketone range. However, solid data to support this is lacking. Always consult with your healthcare provider before making changes related to your medical treatments.
• 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.⁸⁰ Higher numbers can also sometimes mean that you’re not getting enough food. And, for people with type 1 diabetes, high ketone levels 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 Amazon⁸¹). 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.

Breath ketone meters

Breath meters provide another method for measuring ketone levels. Some breath meters give a range of ketosis — mild, moderate, or high — while others give a quantitative result. The up-front cost to breath meters is usually higher than blood meters, but the long-term cost may be lower for those who test frequently, as there are no recurring expenses as there are with blood ketone testing strips.

Which method is best? That depends on your goals and how often you want to test. Diet Doctor’s own Jenni Callihan tested numerous products and her guide describes the benefits and drawbacks to each device.

How to achieve higher ketone levels

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.

In an effort to improve fat-burning, thereby increasing ketone levels, you may consider adding intermittent fasting or exercise to your routine (see tips #14 and #15 above).

Finally, make sure you are eating adequate amounts of protein. A keto diet for weight loss should be at least a moderate protein diet. We recommend 1.2 to 2.0 grams per kg of reference body weight per day.⁸² Check out our target protein ranges to find out how much protein you should be aiming for each day.

If it doesn’t work

Having higher ketone levels most of the day for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet.⁸³ 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 are 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.⁸⁴ Unfortunately these meters can be quite expensive to use, depending on how often you test. Fortunately, with more competition, the price of test strips has come down to about $1 per strip.

Here’s a complete package⁸⁵ 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 purposefully try to increase your ketone levels – 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, nutritional 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 those without diabetes don’t experience. 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

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 medicines are a billion dollar industry.

So do they work? Yes, somewhat. But the majority are not as effective as you might think and they may come with significant side effects.

Most available drugs result in modest weight loss (about 5% of body weight on average), sometimes at the expense of bothersome side effects. More recent medications offer greater weight loss, up to 10 or even 15% of body weight, but in order to maintain any weight loss benefit you receive, you must continue the drug indefinitely.⁹⁷ That’s right – if you stop the drug, you will likely regain the weight you lost, plus extra if your weight was already on an upward trajectory before starting the drug.

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.⁹⁸ 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 that are FDA-approved for less than 12 weeks of continuous use. These drugs are not approved in the EU. Examples include:

• Phentermine
• Phendimetrazine
• Benzphetamine

In the US, phentermine is relatively inexpensive, generally well-tolerated, and modestly effective for many people. Because it is only FDA-approved for short-term use, many doctors specializing in weight management will continue to prescribe it “off-label” as a long-term strategy, if the person is doing well on the drug, as long as that person is willing to accept the risks. To date, there have not been any studies documenting negative consequences of this strategy.

Nonetheless, these drugs have the potential side effects of insomnia, heart palpitations, headache, and elevated blood pressure.⁹⁹ It is therefore important to be monitored closely, at least in the first few months of treatment, to make sure that blood pressure and heart rate aren’t rising too much. Also note that these drugs are controlled substances, requiring a special prescription.

The “fat blocker” pill

Let’s move on to another older drug, Xenical (orlistat), also for sale prescription-free in a lower dose as Alli.

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 – mostly seen if consuming a meal with a significant amount of dietary fat – include stomach cramping, gas, leaking oily stool, and being unable to control bowel movements.

Because the negative reinforcement of these side effects encourages the user to avoid dietary fat, this medication is generally incompatible with a low-carb diet, which tends to be higher in fat. 

However, if your version of low carb tends to be very high in protein and low in fat, this pill might give you that extra boost you need; otherwise, you may want to forget about orlistat. Many doctors already have.

Combination therapy

Qsymia combines a small dose of phentermine (see “Older appetite suppressants,” above) with a small dose of topiramate, an old anti-seizure drug. This is available in the US, but it got rejected in Europe (where the risks were judged worse than the benefits).

Qsymia, like most other weight loss pills, can be modestly effective if pricey. But the side effects are sometimes intolerable: drowsiness, fatigue, depression, attention disturbance, memory impairment, and impaired psychomotor skills (i.e. becoming clumsy).

Contrave (US) or Mysimba (EU) is a combination of bupropion (an old antidepressant) and naltrexone (an old opioid receptor blocker). This is another modestly effective, pricey drug that works on brain receptors to control appetite. Side effects include: nausea, constipation, headache, risk of suicidal thoughts and seizures.

The reigning champion

And then there is the reigning champion of weight loss drugs — GLP1 agonists including Saxenda (liraglutide) and Ozempic or Wegovy (semaglutide). 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.

Liraglutide 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.¹⁰⁰

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.¹⁰¹

Unfortunately, Saxenda can cost upwards of $1000 per month. In both the US and Europe, Victoza (the same drug at half the dose) may be significantly less expensive. At this lower dose, the resulting weight loss is about 75% of the weight loss seen with Saxenda. Victoza is currently approved only for treating type 2 diabetes.¹⁰²

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.

Semaglutide, another GLP-1 analogue (similar to liraglutide), has been used to control blood sugar in type 2 diabetes since 2017. It has also been found to promote substantial weight loss – likely better than any drug currently available – in a trial of overweight people without diabetes.¹⁰³ TThe FDA approved semaglutide for use with weight loss, and many feel this it is a “gamechanger” when it comes to medical weight loss.

The bonus

If you have type 2 diabetes, there is another class of diabetes drug that can result in noticeable weight loss: the SGLT 2 inhibitors. Examples include: Farxiga (dapagliflozin), Invokana (canagliflozin), Jardiance (empagliflozin), and Steglatro (ertugliflozin).

Unfortunately, these drugs carry an increased risk of ketoacidosis in both type 1 and type 2 diabetes; this risk may be accentuated by a strict low-carb or keto diet. Therefore, it’s not recommended to take a medication in this class while on a strict low-carb diet.¹⁰⁴

The bottom line

There is no weight loss drug that easily makes people thin. These medications all have potential side effects and most are not very effective.

While GLP-1 analogues like liraglutide and semaglutide show promise, they are incredibly expensive and, like all weight loss drugs, they only work for as long as you take them.

Many people who want to lose weight have more than 5-10% to lose. That’s why even the best weight loss drug can only be an optional complement to dietary and lifestyle interventions. 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.

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