The Endocrine Society has issued a Clinical Practice Guideline (CPG) on pharmacological strategies for managing obesity and promoting weight loss. The guideline has been published online in the Journal of Clinical Endocrinology and Metabolism (JCEM).

Diet, exercise, and behavioral modifications are recommended to be part of all obesity management approaches; other tools such as weight loss medications and bariatric surgery may also be combined with behavioral changes to reduce food intake and increase physical activity. Anti-obesity medications approved by the Food and Drug Administration (FDA) could be appropriate for patients who have been unable to successfully lose weight and maintain a goal weight if they meet the criteria on the drug’s label.

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Additional guideline recommendations include:

  • Weight loss medication should be continued if a patient responds well and loses ≥5% of their body weight after three months. The prescription should be stopped and an alternative medication or approach considered if the patient experiences side effects or if the medication is ineffective.
  • Patients with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments, due to potential weigh gain associated with certain diabetes medications. Clinicians are advised to discuss medications’ potential effects on weight with patients.
  • Angiotensin converting enzyme inhibitors (ACEs), angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) should be used as a first-line treatment for hypertension in obese patients with type 2 diabetes; these treatments are likely to contribute to weight gain compared to beta-adrenergic blockers.
  • Clinicians should fully inform patients taking medications that may impact their weight (such as antidepressants, antipsychotics, and antiepileptic drugs) about this potential side effect and provide estimates of each option’s anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate treatment options.
  • Phentermine and diethylpropion should not be used in patients with uncontrolled hypertension or a history of heart disease.

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