For appropriate patients, pharmacological treatments are part of a comprehensive approach to long-term weight management.
The Principles of Pharmacology
Three guiding principles should be followed when considering pharmacotherapy for patients with obesity1
Reinforce patient efforts
Pharmacotherapy is meant to reinforce patient lifestyle efforts, not replace them.
Understand side effects
Health care professionals and patients should both be familiar with the medication and its potential side effects and contraindications.
Every patient is different
If clinically meaningful weight loss (≥5%) is not achieved after 3-4 months, a new treatment plan should be implemented.
Most patients living with obesity are not able to achieve and maintain a healthy weight with healthy eating and increased activity alone2
Some pharmacological treatments may benefit patients who:
Have tried lifestyle changes but can’t reach a healthier weight
- Have tried lifestyle changes but can’t reach a healthier weight
Are regaining weight after losing it
- Are regaining weight after losing it
Have a BMI of ≥27 kg/m2 and a weight-related comorbidity
- Have a BMI of ≥27 kg/m2 and a weight-related comorbidity
Have a BMI that is >30 kg/m2
- Have a BMI that is >30 kg/m2
Different pharmacological medications may help the patient to lower appetite, increase energy expenditure, decrease the amount of fat the body absorbs, or reduce cravings.2,3
Treatment plans that include pharmacotherapy, as an adjunct to healthy eating and increased physical activity, may be more effective than any of those alone4
From a 1-year study of 224 patients with BMI of 30 to 45 kg/m2
Significant weight loss
Patients who received combined therapy (medication with lifestyle counseling) lost significantly more weight at weeks 18, 40, and 52 than all other treatment groups (P<0.001).4
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From a 1-year study of 224 patients with BMI of 30 to 45 kg/m2, randomly assigned to receive medication (sibutramine) alone, lifestyle modification with brief therapy, or medication with lifestyle-modification counseling (combined therapy).4
From a 1-year study of 224 patients with BMI of 30 to 45 kg/m2, randomly assigned to receive medication (sibutramine) alone, lifestyle-modification counseling, or medication with lifestyle-modification counseling (combined therapy).4
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A total weight-management plan
Patients' weight history
1. Bray GA, Fruhbeck G, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016;387(10031):1947-1956.
2. Garvey WT, Mechanick JI, Brett EM, et al; and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203.
3. Kim GW, Lin JE, Blomain ES, et al. Antiobesity pharmacotherapy: new drugs and emerging targets. Clin Pharmacol Ther. 2014;95(1):53-66.
4. Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353(20):2111-2120.