Obesity is a chronic, multifactorial disease characterized by excessive accumulation of body fat. It has emerged as a global health concern due to its rapidly increasing prevalence and its association with multiple co-morbidities such as type 2 diabetes, hypertension, cardiovascular diseases, and certain cancers, and mental health disorders. Lifestyle interventions, including dietary modifications, increased physical activity, and behavioral changes, remain the cornerstone of obesity management. However, in cases where lifestyle modifications alone are insufficient to achieve or maintain weight loss, pharmacological interventions might be considered.
- Provides an adjunct to lifestyle interventions. But medications do not take the place of physical activity and healthy eating. Medications work best when combined with a lifestyle program. Studies report that some people taking prescription weight management medications lose 10% or more of their starting weight, but results vary by medications and by the person.
- Medication management can bridge the gap between lifestyle modifications and bariatric surgery. Combinations of different medications with complementary actions can optimize efficacy for weight management and minimize adverse effects.
- FDA guidelines recommend that weight loss medicines may be considered for people who have tried lifestyle changes and meet one or more of the following:
- BMI equal to or greater than 30.
- BMI equal to or greater than 27 with one or more obesity related conditions such as high blood pressure or diabetes.
Orlistat (Alli, Xenical):
Mechanism: Inhibits gastrointestinal lipases, reducing fat absorption.
Side Effects: Oily spotting, flatus with discharge, fecal urgency.
Phentermine-Topiramate (Qsymia):
Mechanism: Phentermine is an appetite suppressant, while topiramate has weight loss side effects.
Side Effects: Tachycardia, insomnia (phentermine); paresthesia, cognitive disturbances (topiramate).
Buproprion-Naltrexone (Contrave):
Mechanism: Bupropion stimulates hypothalamic pro-opiomelanocortin (POMC) neurons increasing energy expenditure, while naltrexone blocks the POMC inhibition, increasing POMC output.
Side Effects: Nausea, headache, dizziness.
Liraglutide (Saxenda):
Mechanism: Glucagon-like peptide-1 (GLP-1) receptor agonist, slows gastric emptying, and increases satiety.
Side Effects: Nausea, diarrhea, and risk of medullary thyroid carcinoma.
Semaglutide (Wegovy Mounjaro Ozempic Injections), (Rybelsus tablets):
Mechanism: GLP-1 receptor agonist.
Side Effects: Nausea, vomiting, diarrhea, abdominal pain, constipation, heartburn, burping.
Benefits: Also used to lower risk of heart attack, stroke and death in patients with type 2 diabetes.
- Potential side effects.
- Drug interactions.
- Cost and insurance coverage.
- Initial follow-up within a month of starting medication.
- Monitor weight, BMI, vital signs, and potential side effects.
- Reassess medication efficacy and safety regularly.
- If less than 5% weight loss is achieved in 3 months.
- If significant side effects are encountered.
- If contraindications develop.
Medications are not a primary treatment for obesity but as an adjunct to lifestyle changes.
Most trials of obesity medications do not extend beyond two years, so long-term safety and efficacy are not always well-established.
Pharmacological interventions for obesity can provide meaningful weight loss in some patients when combined with lifestyle modifications. It is imperative to consider the risk-to-benefit ratio, potential side effects, and each individual patient’s medical history and comorbidities when prescribing these medications. Regular follow-up is essential to monitor efficacy, safety, and to make necessary adjustments to the treatment plan.
Always remember that collaboration with dietitians, physical therapists, psychologists, and other healthcare professionals can offer a comprehensive and multidisciplinary approach to obesity management.
At Mercie Health and Wellness we offer a holistic approach to patient care. Comprehensive assessment and integrated therapeutic strategies can optimize outcomes for affected individuals, addressing both their physical and mental well-being. Contact Mercie Health and Wellness in Katy, Texas to schedule a consultation to learn more about mental health problems, receive the correct diagnosis and all your treatment options. Located in Katy Texas, Mercie Health regularly sees patients from Richmond, Cinco Ranch, and Sugar Land, Texas.
At a Glance
Dr. Sylvia Udokoro Nwakanma
- Doctor of Nursing Practice (DNP)
- Double Board Certified in Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) and Family Nurse Practitioner (FNP-C)
- Author of My Clinical Companion: Identifying Psychiatric Disorders and Developing Accurate Diagnosis
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