As a complicated and multi-faceted disease, obesity requires a spectrum of treatment options for effective results, from basic lifestyle changes to bariatric procedures and medication. Reducing hunger, increasing satiety, and in some cases, affecting the way nutrients undergo gastrointestinal absorption, antiobesity medications may be helpful for some patients.
Adults with a body mass index (BMI) of ≥30 kg/m2 or a BMI of 27 kg/m2 with adverse consequences of obesity (eg, diabetes mellitus, hypertension [HTN], or dyslipidemia) are good candidates for antiobesity medication.
Despite their effectiveness, antiobesity medications can be overlooked as a treatment option. In my professional opinion, failing to consider available Food and Drug Administration (FDA)-approved antiobesity medications as part of the comprehensive treatment of obesity is a failure to keep the oath we took as physicians—to do no harm. If not yet comfortable with comprehensively treating obesity, including managing antiobesity medications, we have the duty to refer that patient to a qualified professional.
Consider the likely results of treating HTN, diabetes, depression, or cancer with lifestyle changes alone. Undoubtedly, lifestyle habits play an extremely important role in each of these diseases, including obesity, but every patient with overweight or obesity deserves to have a knowledgeable discussion with an experienced clinician about the risks and benefits of adding an FDA-approved antiobesity medication to their treatment plan. Here are some points to keep in mind when considering antiobesity medication for your patients.
Unfortunately, antiobesity medications tend to trigger heightened concern among many physicians. I was included in this group before learning the facts. It is important that we educate ourselves about this class of medication before jumping to conclusions and eliminating them from our armamentarium. Obesity is at epidemic proportions in the US, and we need every safe and effective tool available to treat it.
To be considered for FDA approval, antiobesity medications must demonstrate efficacy of at least 5% weight loss compared to placebo. Average efficacy for currently available antiobesity medications ranges from 3%-15% loss of total body weight. Not all the FDA trials undertaken to approve these medications included a comprehensive approach to nutrition, physical activity, and behavior modification. Thus, in theory, obesity medicine specialists have the potential to achieve even better results.
Just like any other class of medications, there will always be situations in which patients should not be prescribed antiobesity agents. The situation will vary depending on the specific drug with 1 exception: antiobesity medications should not be used during pregnancy and lactation.
Monitoring patients who are taking antiobesity medications is vital not only for the obvious reason to ensure there are no adverse side effects, but also to ensure that the medications are having their intended effect and the patient is making progress. Remember,success does not always mean active weight loss but can also mean limiting weight gain. If a patient is consistently gaining weight on an antiobesity medication, something is not right and a change to the treatment plan is necessary.
Our knowledge of obesity continues to evolve. To learn the latest from the best in obesity treatment, join the Obesity Medicine Association’s (OMA) upcoming spring conference, where I will be presenting a session about the importance of antiobesity knowledge. OMA also offers a variety of digital tools, webinars and educational resources for providers to leverage best practices. To learn more about OMA or to become a member, visit www.obesitymedicine.org/join.
Jennifer Seger, MD, Diplomate ABOM, ABFM, originally established a family medicine practice in San Antonio, where she developed a strong interest in wellness and preventative health care. Over time she made the decision to dedicate her practice to the prevention and treatment of obesity and became a diplomate of American Board of Obesity Medicine in 2011.
Dr Seeger currently serves as the medical director of the Comprehensive Medical-Surgical Program at BMI of Texas, which offers an integrated and comprehensive approach to the treatment of obesity. She previously served as a Board Trustee for OMA and recently completed two terms on the ABOM Board of Directors. Dr Seger is active in her community and enjoys speaking at local events to raise awareness about obesity and working with medical students in the Obesity Medicine elective she created.