From the Guidelines
For a 42-year-old female with a BMI of 28 who is struggling with appetite control and weight gain, I strongly recommend considering semaglutide 2.4 mg with lifestyle modifications, as it has been shown to have a significant net benefit in weight loss and glucoregulatory benefits, according to the most recent and highest quality study 1. When selecting a medication for weight loss, it is essential to consider the patient's clinical profile, comorbidities, preferences, costs, and access to therapy. The American Gastroenterological Association (AGA) recommends adding pharmacological agents to lifestyle interventions for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions alone 1. Some key points to consider when prescribing weight loss medications include:
- Semaglutide 2.4 mg has been associated with an increased risk of pancreatitis and gallbladder disease, and gradual dose titration may help mitigate adverse effects such as nausea and vomiting 1.
- Phentermine-topiramate ER may be preferentially used in patients with comorbid migraines, but should be avoided in patients with a history of cardiovascular disease and uncontrolled hypertension 1.
- Naltrexone-bupropion ER may be considered for the treatment of overweight or obesity in patients who are attempting smoking cessation, and in patients with depression, but should be avoided in patients with seizure disorders and used with caution in patients at risk of seizures 1.
- Liraglutide 3.0 mg has glucoregulatory benefits and is also approved for the treatment of T2DM, but has been associated with an increased risk of pancreatitis and gallbladder disease 1. Before starting medication, it is crucial to implement lifestyle changes, including:
- A 500-calorie daily deficit
- Increased protein intake (25-30% of calories)
- Regular exercise (150+ minutes weekly of moderate activity)
- Drinking plenty of water before meals
- Including high-fiber foods to promote fullness A healthcare provider should evaluate for contraindications, monitor side effects, and determine the most appropriate option based on medical history and preferences.
From the FDA Drug Label
From a mean baseline body weight of 94 kg, there was a mean reduction of 2.7 kg for liraglutide injection 1.2 mg, 3.3 kg for liraglutide injection 1.8 mg, and 0. 8 kg for sitagliptin 100 mg The mean BMI was 32.8 kg/m 2. Treatment with liraglutide injection 1.2 mg and liraglutide injection 1. 8 mg resulted in statistically significant reductions in HbA1c relative to sitagliptin 100 mg
Liraglutide may be considered as an appetite suppressant for a female patient with a BMI of 28, as it has been shown to result in a mean weight reduction of 2.7-3.3 kg in clinical trials 2. However, it is essential to note that liraglutide is primarily used for the treatment of type 2 diabetes mellitus, and its use as an appetite suppressant should be carefully evaluated by a healthcare professional.
- Key considerations:
- Liraglutide has been shown to be effective in reducing body weight in clinical trials.
- The patient's BMI is 28, which is considered overweight, and liraglutide may be a suitable option for weight management.
- However, liraglutide is not specifically approved for use as an appetite suppressant, and its use for this purpose should be carefully monitored by a healthcare professional.
From the Research
Appetite Suppressants for Females with BMI 28
- For a 42-year-old female with a BMI of 28 who has been gaining weight and struggles with controlling appetite, several appetite suppressants can be considered 3, 4, 5, 6, 7.
- The following medications have been approved by the FDA for chronic weight management: orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide 3.
- A study comparing the efficacy of anti-obesity medications found that phentermine use was associated with a significantly higher prevalence of ≥5% weight loss than the use of other medications, except for liraglutide 5.
- Another study found that phentermine-topiramate and liraglutide were associated with the highest odds of achieving at least 5% weight loss 6.
- The Number Needed to Treat (NNT) and Number Needed to Harm (NNH) analyses can be used to compare the efficacy and tolerability of different medications, with phentermine-topiramate combination having the best NNT and bupropion-naltrexone combination having the best NNH 7.
Medication Options
- Phentermine/topiramate: associated with significant weight loss and improved cardiometabolism 3, 6.
- Liraglutide: associated with significant weight loss and improved cardiometabolism 3, 6.
- Naltrexone/bupropion: associated with significant weight loss, but may have adverse effects in some individuals 3, 6.
- Orlistat: associated with modest weight loss, but may have gastrointestinal side effects 3, 6.
Considerations
- When selecting an anti-obesity medication, it is essential to consider the patient's clinical presentation, mechanism of action, side-effect profile, efficacy, and NNT and NNH values 7.
- Drug therapy should be initiated in obese individuals after weighing its benefits and risks 3.
- Lifestyle interventions, such as dietary changes and increased physical activity, should be used in combination with medication for optimal weight loss results 3, 4.