From the Guidelines
The current treatment guidelines for weight loss or obesity treatment strongly recommend the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity who have an inadequate response to lifestyle interventions. The guideline panel suggests the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER for long-term management of overweight and obesity, based on moderate certainty evidence 1. Some key points to consider when treating obesity include:
- The use of pharmacotherapy in addition to lifestyle intervention for adults with a body mass index (BMI) of 30 kg/m2 or higher, or 27 kg/m2 or higher with weight-related complications 1
- The recommendation against the use of orlistat due to low certainty evidence 1
- The identification of the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap, indicating a need for further research 1
- Lifestyle interventions, such as reducing caloric intake and increasing physical activity, should be the foundation of obesity treatment
- Medications, such as semaglutide and liraglutide, can be effective for long-term weight management, but should be used in conjunction with lifestyle changes 1
- Regular monitoring and individualized treatment plans are crucial for achieving and maintaining weight loss.
From the FDA Drug Label
Phentermine Hydrochloride, USP 15 mg and 30 mg is indicated as a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index greater than or equal to 30 kg/m 2, or greater than or equal to 27 kg/m 2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).
The current treatment guidelines for weight loss or obesity treatment with phentermine include:
- Short-term use: Phentermine is indicated for short-term use (a few weeks) as an adjunct to a regimen of weight reduction based on exercise, behavioral modification, and caloric restriction.
- BMI criteria: Patients with an initial body mass index (BMI) greater than or equal to 30 kg/m2, or greater than or equal to 27 kg/m2 in the presence of other risk factors, are eligible for treatment.
- Lifestyle modifications: Treatment should include exercise, behavioral modification, and caloric restriction in addition to phentermine.
- Individualized dosage: The dosage should be individualized to obtain an adequate response with the lowest effective dose 2.
- Contraindications: Phentermine is contraindicated in patients with a history of cardiovascular disease, during or within 14 days following the administration of monoamine oxidase inhibitors, and in patients with hyperthyroidism, glaucoma, agitated states, history of drug abuse, pregnancy, or nursing 2.
From the Research
Current Treatment Guidelines for Weight Loss or Obesity Treatment
The current treatment guidelines for weight loss or obesity treatment involve a combination of lifestyle interventions and medical treatment.
- Lifestyle interventions include dietary therapy, increased physical activity, and behavioral therapy 3, 4, 5.
- Medical treatment options include pharmacotherapy, such as orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide, which have been approved by the FDA for chronic weight management 3, 6, 7.
- Surgical therapy, such as bariatric surgery, is often necessary in morbidly obese patients and generally results in more significant and long-lasting weight loss than other treatments 4, 5.
Pharmacotherapy Options
Pharmacotherapy options for weight loss include:
- Orlistat, which has been shown to induce significant weight loss and long-term weight loss maintenance 3, 4, 6, 7.
- Phentermine/topiramate, which has been shown to result in significant weight loss and improved cardiometabolism 3, 6, 7.
- Liraglutide, which has been shown to result in significant weight loss and improved cardiometabolism 3, 6, 7.
- Semaglutide, which has recently emerged as a promising treatment option for weight loss, producing an average of 15% weight loss at 1 year 6, 7.
- Setmelanotide, which is approved as a therapy for those with some of the ultra-rare genetic diseases characterized by severe, early onset obesity 7.
Importance of Tailored Treatment Approaches
It is essential to tailor treatment approaches to individual patients, taking into account their chronic conditions, comorbidities, and preferences 3, 6.
- A detailed analysis of the mechanisms of action, dosing regimens, efficacy in weight loss, safety profiles, and impact on obesity-related comorbidities is necessary to determine the most effective treatment option for each patient 6.
- Integrating pharmacotherapy with lifestyle interventions is crucial to achieve sustainable weight management 6.