From the Guidelines
Weight loss options for patients should prioritize a comprehensive approach combining lifestyle modifications, medications, and sometimes surgical interventions, with a focus on GLP-1 receptor agonists such as semaglutide and tirzepatide, which have shown significant weight loss benefits, as seen in studies 1. The cornerstone of weight management is a calorie-restricted diet (typically 500-1000 calories below maintenance needs) combined with regular physical activity (150-300 minutes of moderate-intensity exercise weekly).
- For pharmacotherapy, FDA-approved medications include:
- Phentermine (15-37.5mg daily) for short-term use
- Orlistat (120mg three times daily with meals)
- Semaglutide (Wegovy, titrated to 2.4mg weekly subcutaneous injection)
- Tirzepatide (Zepbound, titrated to 15mg weekly subcutaneous injection)
- Naltrexone-bupropion (two tablets twice daily, each containing naltrexone 8mg/bupropion 90mg)
- Liraglutide (Saxenda, titrated to 3mg daily subcutaneous injection)
- These medications work through various mechanisms including appetite suppression, reduced fat absorption, or enhanced satiety.
- For patients with BMI ≥40 or ≥35 with obesity-related complications, bariatric surgery options like gastric bypass, sleeve gastrectomy, or adjustable gastric banding may be considered, as supported by studies 1. Treatment should be individualized based on patient characteristics, comorbidities, and preferences, with regular monitoring for efficacy and side effects, and consideration of the potential benefits and risks of each treatment option, as discussed in studies 1. Behavioral support including cognitive behavioral therapy and motivational interviewing enhances long-term adherence and success. In comparison to Contrave or Adipex, GLP-1 receptor agonists such as semaglutide and tirzepatide have shown more significant weight loss benefits, making them a preferred option for patients, as seen in studies 1.
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 following are weight loss options to discuss with a patient:
- Phentermine (Adipex): a short-term adjunct in a regimen of weight reduction based on exercise, behavioral modification, and caloric restriction for 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.
- GLP-1 receptor agonists: although not directly mentioned in the provided drug labels, GLP-1 receptor agonists are a class of medications that can be used for weight loss in patients with a 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.
- Contrave: not directly mentioned in the provided drug labels, but Contrave is a medication that can be used for weight loss in patients with a 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. It is essential to note that the provided drug labels do not directly compare the efficacy and safety of these weight loss options. Therefore, the choice of medication should be based on individual patient factors and clinical judgment 2, 2, 2.
From the Research
Weight Loss Options
The following are some weight loss options to discuss with a patient:
- Lifestyle modification, including diet, physical activity, and behavior change therapies 3, 4
- Pharmacological interventions, such as:
- Bariatric surgery, for individuals with severe obesity or moderate obesity complicated by co-morbid conditions that is not responsive to non-surgical approaches 3
Comparison of GLP-1 Drugs and Other Options
GLP-1 receptor agonists, such as liraglutide and semaglutide, have been shown to be effective for weight loss, particularly when used in combination with lifestyle modification 5, 6, 7. In comparison, naltrexone/bupropion (Contrave) and phentermine/topiramate (Adipex) are also approved for weight loss, but may have different mechanisms of action and side effect profiles 3, 5, 6. The choice of medication will depend on individual patient factors and medical history.
Considerations for Weight Loss Treatment
When discussing weight loss options with a patient, it is essential to consider their individual needs and circumstances, including their medical history, lifestyle, and personal preferences 3, 4. A comprehensive treatment plan should include a combination of lifestyle modification, behavioral strategies, and pharmacological interventions, as needed 3, 5, 4, 6. Regular monitoring and follow-up are also crucial to ensure the safe and effective use of weight loss medications 3, 5, 6.