Pharmacologic Management of Obesity: Endocrine Society's New Guidelines

Link found between shorter sleep and obesity risk
Link found between shorter sleep and obesity risk

In January, 2015, the Endocrine Society issued an evidence-based clinical practice guideline for the pharmacologic management of obesity (co-sponsored by the European Society of Endocrinology and the Obesity Society).1 The authors agree with the opinion of prominent medical societies that obesity is a disease.2 They note that, while greater weight loss is most beneficial, even modest (5%–10%) weight loss has been shown to produce significant improvement in many conditions.2,3

The rationale for pharmacologic treatment of obesity is that permanent weight loss cannot always be achieved or maintained exclusively with reductions in food intake and increases in energy expenditure. Weight loss medications “reinforce” behavioral changes by affecting appetite or blocking fat absorption. While pharmacotherapy does not lead to long-term thermogenesis, the medications increase satiety and decrease hunger, enabling long-term reduction of energy intake.1-3,6

Care of the Patient Who is Overweight or Obese


Diet, exercise, and behavioral modification should be included in all obesity management approaches for those with body mass index (BMI) ≥25kg/m2. Pharmacotherapy is recommended for patients with BMI ≥27kg/m2 with comorbidity, or BMI >30kg/m2. Bariatric surgery is recommended for patients with BMI ≥35kg/m2 with comorbidity, or BMI >40kg/m2. Drugs may “amplify adherence to behavior change and may improve physical functioning such that increased physical activity is easier in those who cannot exercise initially.” Advantages and disadvantages of weight loss medications are listed in Table 1.

Table One


 
 Drug

 Advantages  Disadvantages
 Phentermine   
 Inexpensive
 Weight loss >3–5% 


 Side effect profile
 No long-term data (1–2 years)
 
 Topiramate/phentermine   
 Weight loss >5%
 Long-term data (1–2 years)

 
 Expensive
 Teratogen
 Lorcaserin  
 Side effect profile
 Long-term data (1–2 years)


 Expensive
 Orlistat prescription  
 Nonsystemic
 Long-term data (1–2 years)


 Weight loss 2–3%
 Side effect profile 
 Orlistat OTC  Inexpensive  
 Weight loss 2–3%
 Side effect profile


 Naltrexone/bupropion  
 Weight loss >3–5%
 Food addiction
 Long-term data (1–2 years)


 Side effect profile
 Mid-level price range
 Liraglutide  
 Side effect profile
 Long-term data (1–2 years)


 Expensive
 Injectable

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