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Building on last week’s discussion about adopting a biohacking mindset for weight management, this post explores additional prescription options that can complement your existing plan.

We’ll break down how medications like Contrave, Qsymia, and metformin might fit into a personalized approach, why they could be considered, and how tailoring your strategy can make a real difference. This post is for informational purposes only, helping you have more informed conversations with your healthcare provider. Let’s dive in and explore more avenues on your weight management journey!

When to Consider Adding Another Medication

If you’ve hit a plateau in your weight management journey or have a contraindication preventing you from taking a GLP-1 medication, you might be wondering what other options are available. Some people have genetic or medical reasons—like a family history of certain cancers or pancreatic disease—that make GLP-1s unsuitable. Others may be “hyporesponders,” meaning they’re seeing results but not at the level they had hoped for.

Weight management is highly individualized, and there’s no one-size-fits-all approach. Before considering additional medications, it’s crucial to assess other key factors—hydration, protein and fiber intake, processed food consumption, exercise, sleep, and stress levels. If you’ve given it your all for months without significant progress, adding another medication might be an option.

Next, we’ll take a closer look at some of the most commonly used prescription medications and how they might fit into a personalized approach.

Qsymia: A Medication for Managing Hunger

If hunger is still a big struggle—even after making adjustments to your plan—Qsymia (a combination of Phentermine and Topamax) might be an option. Some people start with it, while others add it later if their current medication isn’t working as well as they’d hoped.

A few key things to know about Qsymia:

•  It’s often an insurance requirement. Many insurance companies make you try and "fail" Phentermine alone or Qsymia before approving other medications.
• It can help with hunger and cravings. This is the main reason it gets prescribed—it can be really effective for appetite control.

However, the side effects can be tough.

• Topamax can cause "brain fog" or make you feel mentally sluggish.
• Phentermine might cause dry mouth and other minor side effects.
• Carbonated drinks can taste weird 

Not everyone tolerates it well. While it works great for some, many people find the side effects outweigh the benefits.

Because of this, Qsymia isn’t a go-to option for most people. But if you’re struggling with hunger and your provider thinks it’s a good fit, it’s worth discussing.

Contrave: A Solution for Urges & Cravings

Another FDA-approved option is Contrave—a combination of Wellbutrin (Bupropion) and Naltrexone. Some providers prescribe them separately as generics, but together, they can be a game-changer for specific challenges.

Who might benefit?

✔️ People struggling with cravings and urges (not necessarily constant hunger).
✔️ Those who have already optimized their nutrition—getting enough protein, balanced meals, and proper hydration—but still experience intense cravings.
✔️ Nighttime snackers who feel like no strategy has worked long-term.

Why consider Contrave?

• If you've tried every trick in the book—balanced meals, habit shifts, substitutions—and cravings still win out, this might help things “click.”
• Some start with it right away, while others add it later—especially if they’re on a GLP-1 medication but still dealing with cravings.

Not everyone responds the same way to appetite suppression, and that’s okay! The goal is always to find the right approach for your physiology.

Orlistat: FDA-Approved but Not Popular

Orlistat (also known as Alli) is another FDA-approved medication, but I hardly ever see it prescribed.

Why?

✔️ Minimal weight loss effects—studies show just a few pounds over 6-12 months.
✔️ Unpleasant side effects—think greasy stool or even fecal incontinence.
✔️ Potential vitamin deficiencies—since it blocks fat absorption, it can also reduce levels of fat-soluble vitamins (A, D, E, K), which requires careful monitoring.
✔️ Poor insurance coverage—despite being around forever, it’s surprisingly not well-covered, meaning many people end up buying the lower-dose over-the-counter version and adjusting their intake.

When might it actually be used?

• Severe constipation cases—in rare situations where nothing else works, some providers might add it in for this reason alone.

Given all this, it’s just not a go-to option for most people—especially with other medications available that offer better results with fewer drawbacks.

Why Metformin Is Gaining Popularity in Weight Management

Metformin is best known for blood sugar management, but it’s also widely used in weight loss—especially for those with insulin resistance. While not FDA-approved for weight loss, small trials in women show around 6% total body weight loss.

For hyporesponders—those struggling to lose weight despite diet and exercise—Metformin can be the missing piece. It works by reducing the liver’s sugar production without causing low blood sugar. Many providers use it alongside other medications to enhance results.

While traditionally seen as a diabetes drug, Metformin plays a growing role in weight management, helping unlock stubborn weight loss when other strategies fall short.

Ultimately, there is no one-size-fits-all approach to weight loss medications. While GLP-1s dominate the conversation, there are other FDA-approved options and even off-label choices like metformin that may be worth considering. The key is working with a knowledgeable provider who can guide you through the best approach based on your unique needs, medical history, and other medications.

Weight stability—not just weight loss—is the ultimate goal. Instead of a one-trick-pony approach, a well-planned strategy can help maintain progress and prevent metabolic swings. If your current plan isn’t working, there are alternatives—and the right provider will help you explore them. 

For a breakdown of specific weight loss percentages for these medications when used alone, check out Anti-Obesity Medications: Part 2 , where I go through the data on different options.