What are the latest treatments for obesity?

Latest Treatments for Obesity

The most effective and comprehensive obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures tailored to individual patients, with tirzepatide showing the greatest pharmacological effect at 21% weight loss after 72 weeks. 1

Current Treatment Options and Their Effectiveness

Behavioral Interventions

• Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months, can achieve 5-10% weight loss through lifestyle changes including weight self-monitoring, dietary counseling, physical activity, and problem solving 1
• Regular follow-up visits (every 4-6 weeks) promote weight loss by influencing behavior change and accountability 1
• Behavioral modification is recommended for individuals at all stages of overweight or obesity, including those attempting dietary change, using pharmacotherapy, or who have undergone bariatric surgery 1
• Stress, unhealthy sleep habits, social dynamics, and environmental factors should be addressed concurrently as part of behavioral modification 1

Nutritional Approaches

• Effective nutritional approaches focus on reducing total caloric intake with dietary strategies based on patient preferences 1
• Regular meals, limited consumption of energy-dense snacks, junk food, and sugar-added beverages are recommended, especially for preventing childhood obesity 1
• Personalized approaches to healthy eating should be based on patient preferences 1

Physical Activity

• Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is crucial for weight-loss maintenance 1
• Approximately 230 minutes of moderate physical activity on most days is recommended 1
• For weight maintenance, increased physical activity (>200 min/week) is often required 1

Pharmacotherapy

Current FDA-Approved Medications for Long-term Use

• GLP-1 receptor agonists: Semaglutide and liraglutide (8-15% weight loss) 1
• Tirzepatide (glucose-dependent insulinotropic polypeptide/GLP-1 agonist): Greatest effect with mean weight loss of 21% at 72 weeks 1
• Phentermine-topiramate: Effective for weight loss when combined with lifestyle interventions 1
• Naltrexone-bupropion: Pooled weight loss of 2.77 kg at 6-12 months 1
• Orlistat: Long-term efficacy and safety demonstrated in a 4-year trial 1

Indications for Pharmacotherapy

• Recommended for adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one obesity-related complication 1
• Particularly indicated for people who:
  • Require more urgent weight loss due to severe obesity
  • Need greater weight loss to manage inadequately controlled obesity-related complications
  • Are unable to achieve or maintain adequate weight loss through lifestyle intervention alone 1
• Pharmacotherapy produces greater weight-loss maintenance than lifestyle alone (difference of 10.3% in the STEP 3 Trial) 1

Endoscopic Procedures

• Intragastric balloons and endoscopic sleeve gastroplasty can achieve 10-13% weight loss at 6 months 1
• These procedures bridge the gap between lifestyle interventions and surgical approaches 1

Metabolic and Bariatric Surgery

• Provides the most significant weight loss, ranging from 25-30% at 12 months 1
• Common procedures include laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass 1
• The Swedish Obese Subjects study showed sustained weight loss of 20 kg at 8 years follow-up for surgically treated patients compared to no change in medically treated patients 1
• Bariatric surgery may be recommended according to national guidelines for individuals with more severe obesity and inadequate response to other treatments 1

Emerging Trends in Obesity Treatment

• Incretin-based therapies (GLP-1 agonists and dual GIP/GLP-1 agonists) are revolutionizing obesity treatment with their multitargeted mechanism achieving weight loss, glycemic control, and decreased cardiovascular mortality 2
• Novel drug delivery systems, vaccines, modulation of gut microbiome, and gene therapy are being explored as potential future strategies 3
• Web-, phone-, or tablet-based electronic tools may support healthful lifestyle changes 1

Treatment Algorithm

1. Initial Assessment:

   • Evaluate BMI, waist circumference, and obesity-related complications 1
   • Assess readiness to change and personal goals 1

2. First-line Treatment:

   • Intensive behavioral interventions with dietary changes and increased physical activity 1
   • Evaluate effectiveness within 3 months 1

3. Second-line Treatment (if inadequate response to lifestyle changes):

   • Add pharmacotherapy for eligible patients (BMI ≥30 kg/m² or BMI ≥27 kg/m² with complications) 1
   • Choose medication based on individual clinical characteristics, comorbidities, and expected degree of weight loss 4

4. Third-line Treatment:

   • Consider endoscopic procedures or bariatric surgery for patients with more severe obesity or inadequate response to previous interventions 1

5. Maintenance Strategy:

   • Long-term follow-up with continued behavioral support 1
   • Consider long-term pharmacotherapy when weight maintenance is inadequate with lifestyle interventions alone 1

Common Pitfalls and Caveats

• Weight regain occurs in 25% or more of participants at 2-year follow-up after behavioral interventions 1
• Many commonly prescribed medications (antidepressants like mirtazapine, amitriptyline; antihyperglycemics like glyburide or insulin) cause weight gain and should be reviewed with alternatives considered 1
• Bariatric surgery requires careful patient selection and long-term follow-up to monitor for nutritional deficiencies and complications 1
• The optimal duration of pharmacotherapy remains undetermined, with most randomized controlled trials examining only up to 12 months of therapy 1