From the Guidelines
Weight loss treatment should always be individualized, considering the person's medical history, life circumstances, preferences, and motivation, and may include a combination of lifestyle changes, medications, and sometimes surgery, as recommended by the most recent guidelines 1. When it comes to weight loss, the approach should be multifaceted, focusing on:
- Lifestyle changes, including a balanced diet with calorie reduction and regular physical activity
- Medications, such as GLP-1 receptor agonists or orlistat, for those with a BMI ≥30 or ≥27 with weight-related conditions
- Surgery, like gastric bypass or sleeve gastrectomy, for severe obesity (BMI ≥40 or ≥35 with comorbidities) According to the latest standards of care in diabetes-2024, individualizing initial treatment approaches for obesity is crucial, and combining treatment approaches may be necessary 1. The choice of treatment should depend on the patient's specific needs and circumstances, and regular monitoring is essential to adjust the approach and manage potential side effects of medications. It's also important to note that the benefits of weight loss, including decreased progression to type 2 diabetes mellitus and positive influences on other obesity-associated cardiovascular risk factors, can be achieved through various means, including diet, exercise, and medications, as highlighted in previous studies 1. However, the most recent and highest quality study 1 should guide our decision-making, prioritizing individualized treatment approaches and combination therapy when appropriate.
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 treatment options for weight loss include:
- Phentermine as a short-term adjunct to a regimen of weight reduction based on exercise, behavioral modification, and caloric restriction.
- The treatment should be individualized to obtain an adequate response with the lowest effective dose.
- The usual adult dose is 15 mg to 30 mg at approximately 2 hours after breakfast for appetite control 2.
From the Research
Treatment Options for Weight Loss
The treatment options for weight loss can be categorized into lifestyle modifications, pharmacotherapy, and bariatric surgery.
- Lifestyle modifications are considered the first-line therapy for patients with overweight or obesity, and include a moderately reduced-calorie diet, increased physical activity, and behavior strategies to facilitate adherence 3.
- Pharmacotherapy, including medications such as orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide, can be used in combination with lifestyle modifications to achieve significant weight loss and improve cardiometabolism 4, 5, 6.
- Bariatric surgery is considered the most effective and long-term treatment for individuals with severe obesity or moderate obesity complicated by co-morbid conditions that is not responsive to non-surgical approaches 7, 5.
Medications for Weight Loss
Several medications are approved for weight management, including:
- Orlistat
- Phentermine/topiramate
- Naltrexone/bupropion
- Liraglutide These medications have shown weight-loss efficacy versus placebo and have been associated with improvements in weight-related comorbidities, such as hypertension, prediabetes, diabetes, or dyslipidaemia 4, 5, 6.
Benefits of Weight Loss
Weight loss of 5-10% is considered clinically meaningful, but greater weight loss may be required to achieve improvements in or remission of certain weight-related complications 7.
- Benefits of large weight loss (≥10%) include improvements in comorbidities such as type 2 diabetes and hypertension, reduced cancer risk, and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life 7.