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MEDICATIONS FOR WEIGHT LOSS

MEDICAL THERAPY FOR WEIGHT LOSS

Anti-obesity drug treatment may be considered for individuals who fail to respond to lifestyle interventions after 6 months of treatment, and have a body mass index (BMI) of >30 or >27 with weight-associated comorbidities.


The main goal of treatment, apart from weight reduction, should be improvement of obesity-associated comorbidities like

  • hyperglycaemia,
  • hyperlipidaemia, and
  • hypertension.


The average effectiveness of available anti-obesity drugs is often limited to a reduction of 5–10% of body weight over a 1-year period. Long-term treatment may have to be considered to prevent weight regain as obesity is considered a chronic illness and combined with a continuous healthy lifestyle regime including increased daily activity and a calorie-deficit diet for the best overall benefit.

TYPE OF PHARMACOTHERAPY

Pharmacotherapy can also be considered as an adjunct to managed weight loss programs or bariatric surgery to maintain weight and prevent weight regain. In some cases, added drug treatment can even facilitate further weight loss.

INJECTION MEDICATION

Weight loss injectable medication can be consider in either daily or weekly types.


The various medications can work by:

  • stimulating the body’s natural production of insulin and inhibiting the release of glucagon to slow digestion,
  • stimulating hormones of hunger and reduces snacking/craving tendencies,
  • reducing appetite and stimulating increased energy expenditure, and



Average weight loss is about 5-10% of baseline body weight.



While some medications are not approved for use in weight loss, they appear to be effective in the reduction weight. This can mean the costs of various medications can be high.



It is generally well tolerated, the main side effects are:

  • nausea, especially during dose escalation, and
  • increased cardiovascular risk.

ORAL MEDICATIONS

Medications used for the management of obesity as a short-term adjunct in a medically monitored comprehensive regimen of weight reduction are designed to either:

  • promotes weight loss by activating the sympathetic nervous system, thus increasing resting energy expenditure, and/or
  • decrease food intake by suppressing hunger.



Average weight loss is about 9% of baseline body weight after 12 months.



These medication when combined with a sound diet program and behaviour modification including exercise can be considered for obese patients with a body mass index (BMI) of 30 kg/m2 or greater.



Some oral medications are not approved for the treatment obesity, but can be initiated in overweight patients with a lower BMI (25 to <30) which increases the risk of morbidity from a number of disorders. 



These medications are unsafe in pregnancy and should be avoided in people in mood and sleep disorders.



OTHER MEDICATIONS

Other oral medications work of different clinical pathways and have been found to reduce weight above placebo in clinical trials.



They can work by reducing dietary fat uptake in the small intestine by about 30%. Thus, efficacy and side effects depend on daily fat intake.



Intestinal side effects (fatty/oily stool, fecal urgency, oily spotting, increased defecation, faecal incontinence, flatus with discharge, and oily evacuation) can be common problems.

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