Best practices for medications approved for weight management

The  American Heart Association/American College of Cardiology/The Obesity Society “guideline for the management of overweight and obesity in adults” and the Endocrine Society clinical practice guideline on obesity pharmaco-therapy both agree that clinicians may consider prescribing weight-reducing drug therapies for patients who: 

(1) struggle to achieve weight goals, 

(2) meet label indications (BMI >30 kg/m2 or BMI 27 kg/m2 with comorbidity), and 

(3) need to lose weight for health reasons (such as osteoarthritis, prediabetes, fatty liver or other conditions). 

Furthermore, the American Association of Clinical Endocrinologists/American College of Endocrinology “comprehensive clinical practice guidelines for medical care of patients with obesity” indicate that clinicians may consider pharmacotherapy as a first-line treatment of weight reduction if patients present with one or more severe comorbidities and would benefit from weight loss of >10%. Those guidelines do not require that patients fail lifestyle therapy before clinicians prescribe medications.

What is the current status of clinical adoption of medications for chronic weight management?

According to the Awareness, Care and Treatment in Obesity Management study, there are a number of misconceptions regarding obesity shared by providers and patients alike, specifically that obesity is not a disease, that patients have the primary responsibility for their problem and for its treatment, that prevention is more important than treatment, and that the risks of treatment should be low.

At present, the FDA has approved nine agents (five for long-term use and four for short-term use)

Dietary supplements, herbal products, over-the-counter products, and other treatments with unproven efficacy and unknown safety have helped undercut the credibility of legitimate weight-management practices by allowing the promotion of agents that are often unsafe, in-effective, and have unproven health claims.

These agents are regulated by the U.S. Federal Trade Commission but not by the FDA, and thus they do not undergo the rigorous testing and review exercised by the FDA when it approves pharmaceutical preparations for patients who are overweight or obese. Many respondents thought that dietary supplements are safer than prescription drugs, and many overestimated the degree of regulatory screening of these products. Evidence to support the effectiveness for weight loss or the safety of these preparations is usually nonexistent. Moreover, variability in the composition of these products adds an additional uncertainty to their use.