From the Guidelines
Medications for weight loss include orlistat, phentermine, liraglutide, and naltrexone/bupropion.
Weight Loss Medications
These medications are effective as adjuncts to diet, physical activity, and behavioral counseling for selected patients with a BMI of 27 kg/m2 or higher, and their potential benefits must be weighed against the potential risks 1.
- Orlistat inhibits pancreatic lipase and causes malabsorption of a portion of ingested fat, with a weight loss of 2.89 kg at 12 months 1.
- Phentermine is a nonadrenergic medication that suppresses appetite and/or stimulates metabolic rate, with a weight loss of 3.6 kg at 6 months 1.
- Liraglutide has been shown to be cardioprotective in doses administered for type 2 diabetes mellitus, and may be used for weight loss in patients with type 2 diabetes 1.
- Naltrexone/bupropion is another option for weight loss, but its use is limited by potential safety concerns, such as increased heart rate and myocardial oxygen demand, in patients with underlying cardiovascular disease or seizure disorder 1.
Considerations for Medication Use
When choosing an anti-obesity medication, it is essential to consider medication interactions, contraindications, and risk of potential adverse effects 1. The decision to continue treatment beyond 1 year should be a shared discussion between the physician and patient, as there are no long-term studies of efficacy or safety to inform this decision 1. Additionally, providers should be knowledgeable about these medications, including their indications, risks, and potential benefits, and should carefully review a patient's medications to identify those that may be contributing to weight gain or limiting weight loss 1.
From the Research
Medications for Weight Loss
The following medications are approved by the FDA for weight loss:
- Orlistat 2, 3, 4, 5, 6
- Phentermine/topiramate 2, 3, 4, 6
- Naltrexone/bupropion 2, 3, 4, 6
- Liraglutide 2, 3, 4, 6
- Semaglutide 2
- Lorcaserin 4, 6 (although it was withdrawn from the market in 2020 due to safety concerns) 4
Efficacy of Weight Loss Medications
Studies have shown that these medications can be effective in inducing weight loss, with semaglutide potentially having superior efficacy 2. The placebo-subtracted weight reduction (%) with the use of anti-obesity drugs for at least 12 months ranges from 2.9% to 6.8% 4.
Safety and Risks of Weight Loss Medications
While these medications can be effective, they may also have potential side effects and risks, such as increased blood pressure with naltrexone/bupropion 6 and adverse outcomes depending on the individual 4. The decision to initiate drug therapy in obese individuals should be made after considering the benefits and risks 4.