New guidelines on treating obesity

16 Jan 2015

The Endocrine Society has issued clinical guidance on the pharmacological treatment of obesity. In the past two years the FDA has approved four new anti-obesity drugs  – lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide. Medications approved for chronic weight management can be useful adjuncts to lifestyle change for patients who have been unsuccessful with diet and exercise alone, the guidelines state.

Other recommendations include:

  1. If patients respond to weight loss medication and lose 5 percent or more of their body weight after three months, the medication should be continued. If the medication is ineffective or the patient has side effects, the prescription should be stopped and an alternative approach considered.
  2. As some diabetes medications are associated with weight gain, people 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.
  3. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers – should be used as a first-line treatment for high blood pressure in obese people with Type 2 diabetes as they are less likely to contribute to weight gain than beta-adrenergic blockers.
  4. When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option’s anticipated effect on weight.
  5. In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.

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