Weight Loss Drugs: What Works?

Laura A. Stokowski, RN, MS

December 13, 2010

Final Thoughts on Anti-Obesity Pharmacotherapy

Obesity is a chronic, relapsing, biologic condition that may well require long-term pharmacotherapy, in the same manner as hypertension and diabetes. To date, however, the average amount of weight lost with most pharmacologic agents has been modest at best, and the typical patient will most likely remain overweight or obese even with ongoing treatment.^[12]

Weight-loss drugs are expensive; neither Medicare nor most insurance plans cover them. In addition, most are associated with adverse effects. Therefore, meeting efficacy criteria for weight loss is not good enough for anti-obesity agents that will be taken by millions of people for many years. The benefits of any weight-loss drug must outweigh the risks, and safety is the overriding consideration.

It is too early to tell whether some of the novel weight loss drugs still in development will offer greater efficacy and safety. What is certain is that drug developers will continue to search for the Holy Grail of anti-obesity drugs as the world's girth continues to expand.

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Cite this: Laura A. Stokowski. Weight Loss Drugs: What Works? - Medscape - Dec 13, 2010.

Wanted: A Pill That Melts Fat
Currently on the Market
Withdrawn or Awaiting Approval
In the Pipeline
Potential Future Therapies
Final Thoughts on Anti-Obesity Pharmacotherapy
References
Sidebar: The Weight-Loss Imperative

The Weight-Loss Imperative

The classifications of "overweight" and "obese" are defined by BMI, calculated from a patient's weight and height. A person with a BMI ≥ 25 kg/m² is considered "overweight" and someone with a BMI ≥ 30 k/m²is considered^, "obese." Using these definitions, 68% of the adults in the United States are overweight, and 34% are obese.^[36]

The days when obesity was considered primarily a cosmetic problem are long gone. We now know that obesity is a complex disease that develops from a combination of genetic and environmental factors, and that the health implications of obesity are vast (see Table). In addition to elevated rates of type 2 diabetes, cardiovascular disease, and cancer, obesity can make surgical management more difficult and result in more postoperative complications.^[37,38]

Evidence of a survival benefit for obesity in select clinical situations is not enough to compensate for the overwhelming health risks, including death, associated with excessive body weight.^[4]

Table. Diseases Associated With Obesity^[39]

Organ System	Conditions
Cardiovascular	Hypertension, peripheral vascular disease, myocardial infarction, cerebral vascular accidents, peripheral venous insufficiency, thrombophlebitis, pulmonary embolism
Respiratory	Asthma, obstructive sleep apnea, obesity-hypoventilation syndrome
Metabolic	Type 2 diabetes mellitus, impaired glucose tolerance, hyperlipidemia
Musculoskeletal	Back strain/disc disease, osteoarthritis
Gastrointestinal	Cholelithiasis, gastrointestinal reflux disease, nonalcoholic fatty liver disease, hepatic cirrhosis, hepatic carcinoma, colorectal carcinoma
Urologic	Stress incontinence
Endocrine/Reproductive	Polycystic ovary syndrome, pregnancy/fetal abnormalities, male hypogonadism, endometrial, breast, ovary, prostate cancer, pancreatic cancer
Dermatologic	Intertriginous dermatitis
Neurologic	Pseudotumor cerebri, carpal tunnel syndrome
Psychologic	Depression, eating disorders, body image disturbance

Clinical Interventions for Obesity

The chief clinical intervention for obesity is lifestyle change, which usually involves counseling and behavioral therapy for reducing caloric intake and increasing physical activity. For patients who fail to lose weight with lifestyle intervention, pharmacotherapy and surgical approaches may be indicated.

The benefits of weight reduction, even on a fairly modest scale (5%-10% of body weight) are well documented. Among other benefits, weight loss is associated with a lower incidence of diabetes, hypertension, and dyslipidemia,^[40]improved urinary incontinence,^[41]and reduced inflammation in osteoarthritis.^[42]Patients with diabetes who lose even small amounts of weight have better metabolic control, fewer cardiovascular risk factors, and lower mortality rates.^[43,44] Continually losing and regaining weight (weight cycling), however, might be worse than maintaining a stable excessive weight. The evidence on weight cycling and threats to health is inconsistent, but raises the question of its safety.^[45]

Unfortunately, the degree of weight loss that is usually achieved with lifestyle intervention alone is insufficient. Efforts to lose weight are often thwarted by a compensatory slowing of the metabolism and high rates of recidivism.^[2]

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Weight Loss Drugs: What Works?

Final Thoughts on Anti-Obesity Pharmacotherapy

Tables

References

Authors and Disclosures

Authors and Disclosures

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Laura A. Stokowski, RN, MS

Sidebar

The Weight-Loss Imperative

Clinical Interventions for Obesity

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