From the Guidelines
Treatment for obesity should prioritize a comprehensive approach combining lifestyle modifications, medications, and surgical interventions, with the goal of achieving significant weight loss and improving overall health outcomes, as supported by the most recent evidence from 2023 1. The cornerstone of treatment is lifestyle changes, including a reduced-calorie diet and increased physical activity. For patients with BMI ≥30 kg/m² or ≥27 kg/m² with obesity-related complications, FDA-approved medications can be considered, such as orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, semaglutide, and tirzepatide, which have been shown to produce significant weight loss, with tirzepatide having the greatest effect, resulting in a mean weight loss of 21% at 72 weeks 1. Some key points to consider in the treatment of obesity include:
- Lifestyle modifications, including dietary changes and increased physical activity, can produce 5% to 10% weight loss, although weight regain is common 1
- Medications, such as GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists, can produce 8% to 21% weight loss 1
- Bariatric surgery can produce 25% to 30% weight loss and is recommended for patients with BMI ≥40 kg/m² or ≥35 kg/m² with obesity-related complications who have not achieved sufficient weight loss with other methods 1
- A multidisciplinary approach involving healthcare providers, dietitians, and behavioral therapists is often the most effective way to address the complex physiological and psychological aspects of obesity 1 The most effective treatment plan will be individualized to the patient's health status, preferences, and goals, with regular monitoring for effectiveness and side effects, and should prioritize the use of evidence-based interventions, as recommended by current guidelines 1.
From the FDA Drug Label
In relatively short-term clinical trials, adult obese subjects instructed in dietary management and treated with “anorectic” drugs lost more weight on the average than those treated with placebo and diet.
The treatment options for a patient with obesity include anorectic drugs such as phentermine, in combination with dietary management.
- Key points:
- Anorectic drugs can result in increased weight loss compared to placebo and diet alone.
- The magnitude of increased weight loss is only a fraction of a pound a week.
- The rate of weight loss is greatest in the first weeks of therapy and tends to decrease in succeeding weeks.
- The total impact of drug-induced weight loss over that of diet alone must be considered clinically limited due to the short duration of the studies 2, 2. Note that phentermine is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and dll-amphetamine) 2.
From the Research
Treatment Options for Obesity
The treatment options for a patient with obesity include:
- Lifestyle modifications, such as a moderately reduced-calorie diet and increased physical activity, which are considered first-line therapy for patients with overweight or obesity 3
- Behavioral interventions, including motivational interviewing and cognitive behavior therapy, to facilitate adherence to lifestyle modifications 3
- Pharmacotherapy, with currently approved medications including orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semaglutide, which can result in significant weight loss and improved cardiometabolism when used in combination with lifestyle interventions 4, 5
- Surgical options, such as bariatric surgery and endoscopic surgery, which can induce more durable weight loss than pharmacotherapy or lifestyle interventions alone, but may be associated with weight regain and weight loss plateau 5
Considerations for Treatment
When considering treatment options for obesity, it is essential to:
- Tailor anti-obesity medications to specific patients depending on their chronic conditions, comorbidities, and preferences 4
- Weigh the benefits and risks of drug therapy, as anti-obesity medications can be costly and may have adverse effects in some individuals 4
- Consider a "continuous treatment model" across the lifespan, as obesity is a chronic disease that requires ongoing management 6
Goals of Treatment
The goals of treatment for obesity include: