New guidance from the American Gastroenterological Association (AGA) recommends that people with obesity use prescription weight-loss drugs, in addition to lifestyle changes like exercise and diet, to meet their weight-loss goals.
The guidelines, which published in the journal Gastroenterology on Thursday, were developed due to advancements recently made in how obesity is treated.
There are now multiple drugs, such as Wegovy, Qysmia, Saxenda, and Contrave, that have been approved to treat obesity, and the doctors who wrote the guidance hope it’ll provide clear information to doctors who treat patients with obesity.
Diet and exercise alone typically fail in the long term because obesity is a biological disease that often requires pharmaceutical interventions, the authors wrote.
Dr. John Magana, a Yale School of Medicine professor and Division Chief of Bariatric and Minimally Invasive Surgery at Yale Medicine, says the new guidance provides a great summary of the FDA-approved medications available along with helpful information on their safety and efficacy, allowing practitioners to figure out what works best for their patients.
“We certainly do know that obesity is a biological disease. By that, I mean it is a disease independent of motivation, it’s independent of psychology — it’s really dependent on physiology,” Magana told Healthline.
The panel strongly supports adding pharmacotherapy to lifestyle interventions, like diet and exercise, to improve health outcomes in people with obesity, which they define as having a BMI over 30kg/m2 or a BMI over 27kg/m2 with a weight-related health complication.
The guidance reviews available literature on the safety and efficacy of the four drugs — Wegovy, Qysmia, Saxenda, and Contrave — and provides clear information on how these drugs work to treat obesity:
Wegovy (semaglutide). Often the drug of choice for obesity, Wegovy has glucoregulatory benefits and delays gastric emptying. This type of drug has been associated with an increased risk of pancreatitis and gallbladder disease.
Qysmia (phentermine-topiramate ER). Qysmia is recommended for patients with obesity who experience migraines. It should not be given to patients with heart disease or uncontrolled hypertension. This drug is also teratogenic, so people with childbearing potential should be counseled about the risks.
Saxenda (liraglutide). Saxenda has glucoregulatory benefits, delays gastric emptying, and helps treat type 2 diabetes. It is associated with an increased risk of pancreatitis and gallbladder disease.
Contrave (naltrexone-bupropion ER). The panel recommends Contrave for patients who are attempting smoking cessation along with patients with depression. It should not be given to patients with seizure disorders or given in conjunction with opioid medications.
The panel also advised against the use of orlistat for obesity due to limited efficacy and a high rate of adverse events. Gelesis100 oral superabsorbent hydrogel is recommended for use only in clinical trials.
Lastly, the panel encouraged the use of phentermine or diethylpropion, with lifestyle changes, rather than lifestyle changes alone.
“This guidance is excellent and provides a comprehensive review of the evidence supporting use of anti-obesity medications in adults with obesity or overweight with weight-related complications in adults that diet and exercise has not worked to help them lose weight,” Dr. Jorge Moreno, a Yale Medicine internist, a board-certified obesity medicine physician, and an assistant professor at Yale School of Medicine, told Healthline.
Obesity rates in the United States have increased dramatically over the past few decades — from 30.5% in 2009-2000 to 41.9% in 2019-2020.
Childhood obesity increased from 6.2% in 1976 to 1980 to 33% in 2017 to 2018.
Obesity has been associated with various health conditions, including heart disease, stroke, type 2 diabetes, sleep apnea, osteoarthritis, and cancer.
According to Moreno, treating obesity has a cascade effect in that it also improves glucose control, cholesterol levels, and blood pressure.
“If you treat obesity in this country, you’re going to treat the vast majority of the burden of disease,” Magana said.
According to the guidance, lifestyle medications are crucial for obesity treatment plans, however, without medicine, they often fail to help patients meet their weight management goals in the long term.
According to Magana, people burn fewer calories dieting than they do when they’re not dieting.
“All of this underscores the fact that your body wants to hold onto its weight and will not let it go — that’s why you need metabolic interventions, like these drugs,” Magana said.
Pharmacological therapies are approved for long-term weight management, however, many doctors don’t prescribe them because they aren’t familiar with the drugs, are unable to access them, or the drugs aren’t covered by patient health insurance plans.
The authors hope the new guidance will expand awareness about the prescription weight-loss drugs approved for obesity and encourage more doctors to use them in obesity treatment plans.
If you’re interested in taking prescription obesity medications, Magana recommends talking to a doctor who can help you weigh the risks and benefits and evaluate other interventions, like bariatric surgery, that may work best for you.
“Deciding which medication is best for the patient depends on several factors including co-existing weight-related conditions, patient’s prior medical history and patient preference,” says Moreno.
New guidance from the American Gastroenterological Association recommends that people with obesity use prescription weight-loss drugs, in addition to lifestyle changes like exercise and diet, to meet their weight-loss goals. The new guidance includes information on the safety and efficacy of multiple drugs used to treat obesity. The authors hope the guidance will encourage more doctors to prescribe the drugs when treating patients with obesity.
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Oct 20, 2022
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