*Initial management – Thorough and honest counseling around healthy eating, physical activity, and health-seeking behavior is essential for every patient seeking weight loss, whether these lifestyle changes are used alone or in combination with anti-obesity medication or bariatric surgery.
*Approach to underlying comorbidities – An important component of the initial evaluation of patients who are overweight or with obesity is the assessment of weight-related comorbid conditions such as diabetes mellitus, dyslipidemia, hypertension, heart disease, sleep apnea, and symptomatic osteoarthritis.
*Candidates for drug therapy — Candidates for drug therapy include those individuals with a body mass index (BMI) ≥30 kg/m2, or a BMI of 27 to 29.9 kg/m2 with weight-related comorbidities, who have not met weight-loss goals (loss of at least 5 percent of total body weight at three to six months) with a comprehensive lifestyle intervention alone.
Choice of agent — Pharmacologic options for the treatment of obesity include semaglutide or liraglutide (by weekly or daily injection, respectively), orlistat, combination phentermine-extended release topiramate (in one capsule), combination bupropion-naltrexone (in one extended-release tablet), phentermine, benzphetamine, phendimetrazine, and diethylpropion.
For patients who are candidates for pharmacologic therapy, the choice of anti-obesity drugs is often governed by the comorbidities and relative contraindications present in the individual patient. As an example, although metformin does not produce enough weight loss (5 percent) to qualify as a “weight loss drug”, it is a good choice for overweight individuals at high risk for diabetes.
When a decision has been made to initiate pharmacologic therapy, our approach takes into account patient comorbidities, patient preferences, cost, and potential adverse effects. Single agents are preferred over combination medications as initial pharmacotherapy. Our team at Fluid Health takes this into account and recommends a treatment plan tailored to you.
Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015; 100:342.