From the Guidelines
The most effective medications for weight loss, as recommended by the latest clinical practice guideline, are semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER, which should be used in addition to lifestyle interventions for adults with overweight and obesity. When considering medication for weight loss, it's essential to evaluate the patient's body mass index (BMI) and the presence of weight-related complications. According to the guideline published in Gastroenterology in 2022 1, pharmacotherapy is strongly recommended for adults with a BMI of 30 kg/m2 or 27 kg/m2 with weight-related complications who have an inadequate response to lifestyle interventions. The recommended medications, including semaglutide and liraglutide, are GLP-1 receptor agonists that have been shown to be effective in promoting weight loss. Phentermine-topiramate ER and naltrexone-bupropion ER are also suggested for long-term management of overweight and obesity. Key points to consider when prescribing these medications include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for potential side effects, such as nausea, constipation, and increased heart rate
- Encouraging patients to make lifestyle changes, including a healthy diet and regular physical activity, to enhance the effectiveness of the medication
- Regularly assessing the patient's progress and adjusting the treatment plan as needed. It's also important to note that orlistat is not recommended due to its limited efficacy and potential side effects, as stated in the guideline 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 recommended medication for weight loss is phentermine. It is indicated for short-term use in patients with a body mass index (BMI) of 30 kg/m2 or higher, or 27 kg/m2 or higher with other risk factors. Key points to consider:
- Indications: short-term adjunct in a weight reduction regimen
- Patient selection: BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 with other risk factors
- Dosage: 15-30 mg daily, individualized to obtain an adequate response with the lowest effective dose 2
From the Research
Recommended Medications for Weight Loss
The following medications are recommended for weight loss:
- Orlistat 3, 4, 5, 6
- Phentermine/topiramate 3, 4, 5, 6
- Naltrexone/bupropion 3, 4, 5, 7, 6
- Liraglutide 3, 4, 5, 7, 6
- Semaglutide 3, 4, 7
- Setmelanotide 3 (approved for those with ultra-rare genetic diseases characterized by severe, early onset obesity)
- Tirzepatide and cagrilintide/semaglutide combination 3 (showing promise for even greater weight loss efficacy in phase 3)
Efficacy of Medications
These medications have been shown to produce weight loss, with semaglutide producing an average of 15% weight loss at 1 year 3, 4. The efficacy of these medications can be enhanced when used in combination with lifestyle interventions such as diet and exercise 7, 6.
Considerations for Prescribing Medications
When prescribing medications for weight loss, clinicians should consider the patient's specific set of circumstances and comorbidities 4, 6. The benefits of losing fat mass may outweigh the potential side effects associated with these medications, particularly in patients at risk of complications from obesity 4.