Weight Loss Drugs: What Works?

Laura A. Stokowski, RN, MS

Disclosures

December 13, 2010

In This Article

Wanted: A Pill That Melts Fat

As Americans become more obese and the associated health problems reach epidemic proportions, the need for a safe and effective weight loss drug has become urgent. Over the years, this quest has been marked with short-lived triumphs and many defeats, leaving patients and clinicians with less than ideal weapons in the fight against obesity.

The few drugs that have actually reached the market in recent years promote weight loss either by boosting the body's basal metabolic rate, blocking the absorption of dietary fat, or suppressing appetite.People who take these drugs typically lose weight for the first 6 months until they reach a plateau that can't be surpassed without increasing exercise or caloric restriction.The problems with many of these agents have been a lack of proven long-term safety, and the fact that when such drugs are stopped, the weight is usually regained.

Most clinicians are aware that pharmacotherapy is not indicated as a first-line therapy for obesity, and should not be initiated until all nonpharmacologic attempts at weight loss (diet, exercise) have failed.[1] It is also important to evaluate other medications that the patient may already be taking, as some may promote weight gain (eg, sulfonylureas, thiazolidinediones, and insulin), thereby negating the effects of anti-obesity drugs.[2]

The decision to prescribe a weight-loss drug involves a careful assessment of the risks and benefits.[3] As a general rule, an effective regimen should help patients lose at least 4 pounds in the first 4 weeks, or 5% of baseline weight in the first 3 months on therapy.

As researchers continue searching for an ideal weight-loss agent, clinicians must work with available therapies while awaiting newer drugs in the pipeline.

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