For the first time, long-term use of four approved anti-obesity drugs has been strongly recommended for adults unable to lose weight through lifestyle changes alone. The new evidence-based guidelines have been issued by the American Gastroenterology Association (AGA) and will be published in the November issue of Gastroenterology.
Dr Perica Davitkov, a professor in the department of medicine at Case Western Reserve University in Cleveland, said the guidelines were the first since diabetes drugs were approved for obesity treatment, and provide clear information for doctors and their patients who battle to lose weight or keep it off with lifestyle changes alone.
Weight loss medications are first-line medical options and should be used along with healthy eating and regular physical activity, according to the guidelines, reports Everyday Health.
The four medications that have been approved have been shown to result in moderate weight loss as a percentage of body weight (reported as the difference compared with a percentage of weight loss observed in the placebo group).
• Semaglutide (Wegovy) weight loss percentage: 10.8%
• Phentermine-topiramate ER (Qsymia) weight loss percentage: 8.5%
• Liraglutide (Saxenda) weight loss percentage: 4.8%
• Naltrexone-bupropion ER (Contrave) weight loss percentage: 3.0% percent
“These medications treat a biological disease, not a lifestyle problem,” said another author, Dr Eduardo Grunvald, of the University of California in San Diego. “Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term. Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver and hypertension.”
Overweight or obese people have an increased risk of death from any cause, as well as stroke, coronary heart disease, and various cancers, according to the Centres for Disease Control and Prevention (CDC).
Obesity first recognised as a disease a decade ago
According to the Obesity Medicine Association, the American Medical Association (AMA) designated obesity a disease in 2013. Although it is influenced by behavioural factors, experts now recognise that genetics, environment, social determinants of health, and biological factors influenced by medications, illnesses and hormones all play a role.
The prevalence of obesity in the US has increased dramatically from 30.5% to 41.9% over the past 20 years, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
More people dieting, but it’s hard to maintain weight loss
A 2020 report from the CDC found that about 17% of Americans report being on a diet – that’s up from 14% in the previous decade. Unfortunately, research suggests that even people who successfully lose weight have a hard time keeping off the kilos. In a meta-analysis of 29 long-term weight loss studies, more than half the lost weight was regained within two years, and by five years more than 80% of the lost weight was regained.
Weight loss meds could slow obesity epidemic
More widespread use of these medications could absolutely slow the obesity epidemic, says Dr Fatima Cody Stanford, MPH, an associate professor of medicine and paediatrics at Harvard Medical School in Boston and an obesity specialist at Massachusetts General Hospital, who was not involved in writing the new recommendations.
Stanford said only 1% of Americans who meet the criteria for weight loss medication actually receive it. “It is important to note that this is not the case with any other chronic disease,” she says, but due in part to the misperception that obesity is a lifestyle choice rather than a disease.
Who is eligible for weight loss medications?
People may be prescribed a weight loss drug if they haven’t been able to lose weight through diet and exercise and meet one of the following:
• Have a BMI greater than 30
• Have a BMI greater than 27 and an obesity-related chronic disease such as type 2 diabetes, heart disease, or obstructive sleep apnea
Stanford strongly recommends these medications for people who haven’t been able to lose weight through lifestyle modifications alone.
“It is important to note that these medications are used chronically, meaning they will not be stopped. Many people think they will go on the medications and come off once they reach a particular weight, but stopping the medications (if they have been effective) will only lead to weight regain,” she says.
guidelines for weight loss
See more from MedicalBrief archives:
Type 2 diabetes reversed by intensive weight management programmes
Maintenance semaglutide injections led to continued weight loss — STEP 4
Scientists say older, common drugs could fight obesity, diabetes and other conditions
Diabetes drug helps obese patients shed weight – US study