January 28, 2015
Guidelines Recommend Weight Loss–Drug Prescriptions
for Some Patients

Boston—Recently approved medications can be valuable in helping patients lose more weight when combined with diet and exercise, according to a new clinical practice guideline issued by the Endocrine Society.

In the past two years, the guidelines note, FDA has approved four new antiobesity drugs—lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide. The new clinical practice guidance, available online and published in the February issue of the Journal of Clinical Endocrinology and Metabolism, offers strategies on how to prescribe the drugs to manage obesity and promote weight loss.

The article also suggests that treatment guidelines are badly needed: According to the 2012 National Health and Nutrition Examination Survey, about 33.9% of adults ages 19 to 79 were overweight, 13.4% were obese, and 6.4% were extremely obese.

“Lifestyle changes should always be a central part of any weight loss strategy,” said task force chair Caroline M. Apovian, MD, of Boston University School of Medicine and Boston Medical Center. “Medications do not work by themselves, but they can help people maintain a healthy diet by reducing the appetite. Adding a medication to a lifestyle modification program is likely to result in greater weight loss.”

In the guideline, the Endocrine Society recommends that diet, exercise, and behavioral modifications be part of all obesity-management approaches, adding that other tools such as weight-loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity.

The task force suggests that patients who have been unable to successfully lose weight and/or maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug’s label.

Further recommendations include:

• Medication should be continued in patients who respond and lose 5% or more of their body weight after 3 months. Medication should be discontinued if ineffective or the patient develops adverse side effects; an alternative drug or approach should then be considered.
• Patients with diabetes who are obese or overweight should be prescribed medications that promote weight loss or have no effect on weight as first- and second-line treatments. The potential effect of medication on weight should be discussed with patients.
• 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 patients with type 2 diabetes. Those blood pressure therapies are less likely to contribute to weight gain than beta-adrenergic blockers.
• When patients need medications that can lead to weight gain—such as antidepressants, antipsychotic drugs, and medications for treating epilepsy—they should be provided with estimates of how each drug is likely to affect weight and play a role in deciding what to use.
• Phentermine and diethylpropion should not be used in patients with uncontrolled high blood pressure or history of heart disease.

The guidelines note that careful prescribing can mitigate some of the weight fluctuations associated with certain types of drugs.

“Many medications commonly prescribed for diabetes, depression, and other chronic diseases have weight effects, either to promote weight gain or produce weight loss,” the authors write. “Knowledgeable prescribing of medications, choosing whenever possible those with favorable weight profiles, can aid in the prevention and management of obesity and thus improve health.”

U.S. Pharmacist Social Connect