Topiramate for weight loss (Topamax)

What are the risks of taking Topamax for weight loss?

Topamax has been used for weight loss in some individuals with binge eating disorder (BED), and though it can be effective in reducing weight, it doesn’t treat the underlying issues of BED. In fact, it can cause disordered eating patterns in people who take it.³

Using Topomax as a weight loss drug can put your health at risk

Research indicates that taking Topamax can be risky to your health, especially for those who have a history of an eating disorder or are vulnerable to disordered eating. One case study assessed seven adolescents who developed disordered eating after taking topiramate. Three of the participants developed an eating disorder after starting Topamax, three had eating disorders prior to taking the medication, and one had been in eating disorder recovery. All of the teens had the same primary symptom of food restriction, while a few also engaged in purging and binging.⁴

Although following a fad diet like the ketogenic diet doesn’t necessarily mean someone has an eating disorder, it can be considered disordered eating. And if an individual is following the keto diet to lose weight, taking Topamax for weight loss could be especially dangerous due to the severe body weight changes, as well as the risk of metabolic acidosis, which occurs when there’s a buildup of acid in the body.

Metabolic acidosis can cause:⁵

• Fatigue
• Hyperventilation
• Stupor
• Cardiac arrhythmias
• Kidney stones
• Bone softening
• Osteoporosis

It can also result in a loss of appetite, leading to even more weight reduction from a reduced-calorie diet, which can exacerbate issues like osteoporosis.⁵

Dangers of rapid weight loss with Topamax

Topamax can lead to rapid weight loss due to appetite suppression. However, losing weight quickly has many health risks, including:⁶

• Vitamin and mineral deficiencies
• Muscle loss
• Malnourishment
• Decreased metabolism

Additionally, using Topamax for weight loss can increase the risk of disordered eating behaviors as well as the risk of developing full-blown eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN). In fact, one study showed that teen girls who engaged in extreme dieting were 18 times more likely to develop an eating disorder than those who didn’t diet.⁷

Further, rapid weight loss can lead to rebound weight gain, something known as weight cycling. Research indicates that weight cycling is worse for your health than never dieting at all and that it can increase your mortality rate or risk of death.⁸

Topiramate side effects and health risks

Topiramate use for weight loss can cause many adverse effects, such as:^1,2

• Nervousness
• Drowsiness
• Numbness in feet or hands
• Shaking or tremors
• Nausea, stomach pain, and constipation
• Excessive menstrual bleeding
• Missed menstrual periods
• Bone pain
• Weight loss

Serious side effects may include:^1,2

• Hyperthermia
• Suicidal ideation
• Impaired liver function and liver disease
• Bloody or cloudy urine
• Painful urination
• Usual bruising or bleeding
• Intense side or back pain
• Fever 

If you experience any troubling side effects of topiramate or an unusual or allergic reaction, call your doctor immediately. They may advise you to stop taking it or may adjust your dose.

Can you overdose on topiramate?

It is possible to overdose on topiramate. Signs and symptoms of a topiramate overdose include:¹

• Vomiting
• Seizures
• Trouble speaking
• Blurred or double vision
• Loss of consciousness
• Agitation
• Shallow, fast breathing
• Irregular heartbeat
• Unresponsiveness 

Unpacking the problem of using medications like topiramate for “weight loss”

People who decide to use medication like topiramate for weight loss are typically influenced by the insidious nature of diet culture. Most people aren’t even aware of how much diet culture affects us, our relationship to food, our movement, our bodies, and the decisions we make daily.

Diet culture is ever-present, in media, pop culture, advertisements, and marketing, at grocery stores, in conversations, at work and in doctor’s offices, on food labels and menus, and beyond. And diet culture, which tells us that body shape and weight are more important than well-being, leads to anxiety about weight gain, body shape, body size, and more.

Diet culture even influences medical decisions. In 2012, the Food and Drug Administration (FDA) approved a combination weight-loss medication consisting of phentermine and topiramate.⁹ These decisions come on the heels of the so-called “obesity epidemic,” which has pathologized living in a larger body, associating fatness with disease. However, weight isn’t an accurate indicator of health, and pathologizing fatness only reinforces fatphobia, diet culture, and healthism.

Just because a medication like Topamax has been approved for weight loss, that doesn’t mean using it is without its risks, both physical and psychological. When you choose to use a rapid weight-loss medication like topiramate, you’re subscribing to harmful beliefs about your body and self-worth. This may be an indication that you’re struggling with disordered eating patterns or even an eating disorder.