Updates on obesity pharmacotherapy

Abstract

Obesity is a chronic, relapsing disease that necessitates a multidisciplinary approach to management. Behavioral changes are the foundation to management, but adjunctive therapy is often warranted, including pharmacologic therapies and/or bariatric surgery. Until recently, treatment options included only short-term therapy (ࣘ12 weeks), and paths beyond that schedule were challenging, as knowledge of the biology of obesity was lacking. With increased recognition of obesity as a chronic, complex medical disease, newer agents have been approved as long-term therapy, and the cornerstone of treatment is chronic behavior and lifestyle change. In the last decade, the Food and Drug Administration (FDA) has approved several new weight loss medications for the chronic management of obesity. In this review paper, we provide the latest updates on obesity pharmacotherapy. The main areas we will cover include (1) pharmacological management of obesity, (2) a review of FDA-approved weight loss medications, (3) comanagement of obesity and its metabolic sequelae (type 2 diabetes mellitus, hypertension, and dyslipidemia), and (4) obesity-centric prescribing for mental illness, neurological disorders, and contraceptive planning.

Targeting bile acid metabolism in obesity reduction: A systematic review and meta‐analysis

“…Although metabolically healthy obesity is possible, it is often transient and a large proportion convert to an unhealthy phenotype in the longer term, 1 emphasizing the importance of preventing and treating obesity. Apart from dietary and lifestyle interventions, pharmacotherapy, for example, Orlistat, has been introduced for weight loss in the moderately obese group 2 . In the morbidly obese group, the popularity of bariatric surgery is growing due to its effectiveness in achieving long‐term weight loss, but the invasiveness and potential complications are of concern 3 .…”

Safety and Effectiveness of Longer‐Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort

“…There are few prior studies examining long-term use of phentermine, particularly as monotherapy for obesity (6,20,22,32). However, in 2012, a new brand-named drug, Phentermine/Topiramate-CR, earned FDA approval for long-term (≥ 12 months) use as a weight-loss medication.…”

“…The most commonly used weight‐loss medication in the United States is phentermine , a sympathomimetic amine that acts by inhibiting appetite and that was originally approved for weight loss in 1959 . Most studies examining phentermine monotherapy have limited treatment duration to less than 12 weeks , aligning with a package insert that recommends that the medication be used as “a short‐term adjunct (a few weeks)” to lifestyle‐based programs . Concerns about longer‐term phentermine use include increased risk of cardiovascular disease (CVD) and potential for addiction .…”

“…Weight‐loss treatment approaches are evolving to favor long‐term therapy, aligning with the new chronic disease model of obesity. Newer antiobesity medications have, accordingly, been approved by the Food and Drug Administration (FDA) for long‐term use (i.e., more than 12 months) . If phentermine monotherapy, which is widely available and low cost, was found to be safe and effective for long‐term use, the impact for obesity treatment could be significant.…”

“…The most commonly used weight-loss medication in the United States is phentermine (16,17), a sympathomimetic amine that acts by inhibiting appetite and that was originally approved for weight loss in 1959 (18,19). Most studies examining phentermine monotherapy have limited treatment duration to less than 12 weeks (20), aligning with a package insert that recommends that the medication be used as "a short-term adjunct (a few weeks)" to lifestyle-based programs (21). Concerns about longer-term phentermine use include increased risk Using data from electronic health records (EHRs), we studied whether adults prescribed phentermine for longer than 12 weeks experienced differential weight loss, change in blood pressure (BP) or heart rate (HR), or increased risk of incident CVD or death compared with adults prescribed phentermine in an on-label short-term episode.…”