The newest pharmacologic options for weight loss
Obesity is adults, defined as a body mass index (BMI) of 30 kg/m2 or greater, refers to excess body fat that increases an individual’s risk for adverse health outcomes. Adults who have a BMI of 40 kg/m2 or greater have a reduced life expectancy and higher rates of a number of conditions, including heart disease; stroke; diabetes; and breast, endometrial, colon, and prostate cancers. Other conditions associated with obesity include osteoarthritis, liver and gallbladder disease, sleep apnea, abnormal menses, and infertility.
More than 33% of adults 20 and older were obese in 2012. This number is steadily climbing. In fact there has been a 21% increase in rate of obesity among women 60 years and older.
There has been a recent explosion of knowledge with pharmacologic options for weight loss. Studies have shown that even a 3-5% reduction in weight can decrease risk of cardiovascular disease and diabetes. The American College of Physicians’ guidelines states that pharmacologic therapy can be offered to obese patients
who fail to achieve weight loss goals
with diet and exercise alone
. Patients should understand that most weight loss occurs in the first 6 months of pharmacologic therapy.
These following medications have been approved by the FDA (Food and Drug Administration).
Orlistat (Xenical, Alli)
: 120 mg three times/day
: 2.89 kg (6.37 lb), about 3% of initial weight
: GI effects
: First line therapy because of long term safety, FDA approved for long-term use, inhibits pancreatic lipase, avoid use in patients who have malabsorption syndromes and cholestasis
: 10 mg two times/day
: 4.0 kg (8.8 lb) to 7.0 kg (15.4 lb), about 3% of initial weight
: CNS effects, GI effects, dry mouth, back pain, cough, and hypoglycemia in those patients who have type 2 diabetes
: Approved by FDA for long term use, many drug interactions, avoid with other serotonergic drugs, do not use in patient with valvular disease
Naltrexone-bupropion SR (Contrave)
: Start with 8 mg/90 mg, then titrate to 32 mg/360 mg per day
: 6.5% of initial weight
: GI effects, CNS effects, dry mouth, risk of suicidal thoughts and behaviors, may elevate heart rate and blood pressure, seizures
: Avoid in patients taking opioids or taking treatment for opioid dependences
Phentermine-topiramate ER (Qsymia)
: 3.75 mg/23 mg per day in the morning for 14 days, then increase to 7.5/46 mg per day, then increase againe to 11.25/69 mg per day for 14 days if patient is losing weight
: Mid dose 8.1 kg (17.9 lb)
High dose 10.2 kg (22.5 lb)
: CNS effects, GI effects, dry mouth, constipation, dysgeusia
: Approved by FDA for long term use, multiple drug interactions, do not use in patients who have heart disease, uncontrolled hypertension, glaucoma, or hyperthyroidism
You can consider managing obesity with any of these weight loss medications approved by the FDA as an adjunct to behavioral strategies, dietary changes, and physical activity. If weight loss is NOT achieved in the first 3 months, the weight loss medication must be changed.
Please see your primary care doctor for information on these weight loss medications.