Medications Indicated for Chronic Weight Management

Abstract

This chapter reviews the medications currently available for chronic weight management in the USA and some other countries and, for those five medications, discusses mechanism of action, efficacy data, and safety profiles. The chapter also discusses principles of prescribing and best practices for managing patients with medications indicated for weight management. Four of the newer agents (lorcaserin, liraglutide 3.0 mg, naltrexone SR/ bupropion SR, and phentermine/topiramate ER) all act primarily in the central nervous system. They regulate appetite and reduce food intake to help patients better adhere to a dietary plan. Orlistat acts peripherally to block absorption of 30% of ingested fat and reinforces adherence to a low-fat diet, thus reducing energy intake. These five newer medications are intended for long-term use to help patients not only lose more weight than with lifestyle changes alone, but also to maintain hard-won weight losses. Best practices in chronic disease prevention and management currently require physicians to help patients manage weight as a pathway to health improvement and those patients who struggle with weight and would derive health benefits from weight loss are candidates for medications. A current trend is to intervene earlier with these medications, especially with patients at higher health risk. The available medications have differing profiles in safety, efficacy, and tolerability. No one medication is right for every patient and the patient’s profile must be matched to the medication profile. Thus, providers caring for patients with obesity-associated risk and diseases should be knowledgeable on how to prescribe for chronic weight management. Finally, if patients have success with a medication and lifestyle change to produce weight loss, the medication should be continued to maintain weight loss. Since weight regain is an issue when medications are stopped, restarting medications is also appropriate.