State of the art medical weight loss is a cominbation of some of the following. A controlled appetite suppressant (phentermine, phendimetrazine, diethylpropion, benzephetamine) for appetite suppression. A medication to increase GLP1 (Victoza or Symlin or Byetta injections). A DPP-4 Inhibitor to prevent the breakdown of GLP1 (Januvia or Onglyza or Tradjenta). Metformin to make the DPP-4 Inhibitor work better. A medication to decrease carbohydrate cravings (Zonegran or Topemax or Naltrexone). A medication to decrease feeding behavior (Wellbutrin). Some combination of these medications can very likely, very safely and effectively, help you lose weight . Limit your calories to no more than 1500 day. Limit your carbohydrates to 8-10 grams per feeding, a total or no more than 20 grams of carbohydrate a day. You will lose weight.