Pharmacological Management of Obesity Guideline Resources

Full Guideline: Pharmacological Management of Obesity
JCEM | February 2016

Caroline M. Apovian (chair), Louis J. Aronne, Daniel H. Bessesen, Marie E. McDonnell, M. Hassan Murad, Uberto Pagotto, Donna H. Ryan, and Christopher D. Still

The 2016 guideline on the pharmacological management of obesity addresses:

  • Management of chronic obesity, including managing comorbid conditions
  • Monitoring progress of weight loss using medication
  • Choosing alternative medications that are weight-losing or weight-neutral in the management of other medical conditions such as T2D, depression and other mental health conditions, chronic inflammatory diseases and arthritis, and epilepsy


Resources



Essential Points

The Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug’s label.
Other recommendations include:

  • If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication should be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
  • Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications’ potential effects on weight with patients.
  • Certain types of medication – angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers – should be used as a first-line treatment for high blood pressure in obese people with Type 2 diabetes. These are effective blood pressure treatments that are less likely to contribute to weight gain than the alternative medication, beta-adrenergic blockers.
  • When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option’s anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
  • In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.

Summary of Recommendations

+ 1.0 Care of the patient who is overweight or obese

+ 2.0 Drugs that cause weight gain and some alternatives

+ 3.0 Off label use of drugs approved of other indications for chronic obesity management