From the Guidelines
The current medications for obesity management are semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER, which have been deemed to have a moderate or large magnitude of weight loss and small or not-substantial harms 1.
Medications for Obesity Management
- Semaglutide 2.4 mg: a glucagon-like peptide-1 (GLP-1) analogue, which reduces energy intake by reducing appetite, increasing satiety, and delaying gastric emptying 1.
- Liraglutide 3.0 mg: a GLP-1 analogue, which mediates weight loss by reducing energy intake and increasing satiety 1.
- Phentermine-topiramate ER: a combination medication that targets different sites simultaneously, having an additive effect on weight loss, with phentermine promoting weight loss by activating the sympathetic nervous system and topiramate reducing caloric intake by modulating gamma-aminobutyric acid receptors, inhibiting carbonic anhydrase, and antagonizing glutamate 1.
- Naltrexone-bupropion ER: a combination medication that activates pro-opiomelanocortin (POMC) neurons in the arcuate nucleus, causing release of alpha-melanocyte-stimulating hormone, which projects to other hypothalamic areas involved in feeding and body weight control 1.
Additional Medications
- Phentermine: an adrenergic agonist that promotes weight loss by activating the sympathetic nervous system, with a recommended dosage of 15-37.5 mg orally once daily 1.
- Orlistat: a medication that reduces fat absorption from the gastrointestinal tract by inhibiting pancreatic and gastric lipases, with a recommended dosage of one 120-mg capsule three times a day with each main meal containing fat 1. It is essential to note that the use of these medications should be individualized to particular complications of a patient and used adjunctively with lifestyle interventions 1.
From the Research
Current Medications for Obesity Management
The following medications are currently approved for long-term use in obesity management:
- Orlistat: works by decreasing fat absorption 2, 3, 4, 5, 6
- Naltrexone extended-release (ER)/bupropion ER (Contrave): works by inhibiting the rewarding and reinforcing effects of food consumption 2, 4, 5
- Phentermine/topiramate controlled-release (Qsymia): results in significant weight loss, but cannot be used in the acute preconception period due to its teratogenic effects 2, 4, 5
- Liraglutide: a GLP1-receptor agonist that reduces food cravings, appetite, and improves insulin sensitivity and satiety 2, 4, 5
- Semaglutide: a GLP1-receptor agonist that reduces food cravings, appetite, and improves insulin sensitivity and satiety 4, 5
- Tirzepatide: a dual GLP-1 and gastric inhibitory peptide agonist that is about to be approved for obesity management 5
Mechanisms of Action and Efficacy
These medications work through various mechanisms, including:
- Suppressing appetite and increasing satiety 2, 4, 5
- Decreasing fat absorption 2, 3, 5, 6
- Improving insulin sensitivity and metabolic health factors 4, 5
- Inhibiting the rewarding and reinforcing effects of food consumption 4, 5
Safety and Considerations
When choosing an anti-obesity medication, it is essential to consider the patient's clinical and biochemical profile, co-morbidities, and drug contra-indications, as well as expected degree of weight loss and improvements in cardio-renal and metabolic risk 5. Additionally, some medications, such as Qsymia, have teratogenic effects and should not be used in the acute preconception period 4.