Weight Loss Medication Guidelines
By Arvind Sommi
Diet and exercise are often insufficient for people with obesity, leading many to pursue alternatives. The American Gastroenterological Association published guidelines on the use of medication for obesity in adults. See which weight loss drugs are ranked the highest.
The United States is in the midst of an obesity epidemic. Adult obesity rates have increased from 30.5% in 2000 to 41.9% in 2020. Similarly, childhood obesity rates from 1980 to 2018 increased from 6.2% to 33%.
Obesity can lead to various complications – including type 2 diabetes, cardiovascular disease, stroke, and sleep apnea. New clinical guidelines standardizing weight loss medications as a first-line therapy could help address this epidemic.
Lifestyle interventions may be insufficient
Lifestyle interventions, such as changes in diet and exercise, are the primary method of weight management. However, clinical guidelines from the American Gastroenterological Association (AGA) suggest that lifestyle changes may have limited effectiveness and may not lead to lasting improvements for most individuals.
Dr. Perica Davitkov, a gastroenterologist at Case Western Reserve University School of Medicine and one of the guideline authors, discussed how, even with lifestyle interventions, “some people gain the weight back or are not able to lose as much weight. It’s not enough to improve the complications of obesity.”
Pharmacological therapies, such as Wegovy (semaglutide), have been approved for long-term management of obesity with high efficacy; however, these medications have not been included in routine clinical care since clinical guidelines did not officially endorse them. This has led to a lack of familiarity with weight-loss medications among healthcare providers and limited access and insurance coverage for people with obesity.
The AGA’s new clinical guidelines provide evidence-based recommendations on the use of pharmacological management of obesity in adults. Davitkov emphasized that these pharmacological options should still be considered in addition to lifestyle modifications.
What do the new guidelines say?
A multi-disciplinary panel of experts conducted a meta-analysis of the randomized controlled trials for FDA-approved medications for obesity management.
The AGA recommends adding pharmacological agents to lifestyle interventions in adults with obesity or overweightness with weight-related complications who have an inadequate response to lifestyle interventions alone.
In addition to evaluating outcomes such as a reduction in body weight, the panel also included a patient representative to assess patients’ values and preferences. The authors also noted that although cost and cost-effectiveness were significant, they did not impact the panel’s decisions.
Recommended weight-loss drugs, ranked in order of effectiveness
Semaglutide (Wegovy®), weight loss percentage: 10.8%
Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
Liraglutide (Saxenda®), weight loss percentage: 4.8%
Naltrexone-Bupropion ER (Contrave®), weight loss percentage: 3.0%
The authors highlighted that Wegovy (semaglutide 2.4 mg) may be prioritized over other anti-obesity medications for the long-term treatment of obesity for most patients due to the magnitude of its benefit. The panel also noted that people with T2D using insulin or sulfonylureas might experience an increased risk of hypoglycemia as glucose levels could drop with weight loss and reduced caloric consumption.
Where is tirzepatide (Mounjaro)?
Tirzepatide was not included in this guideline because it has not yet been approved by the FDA for a weight loss indication. However, the U.S. FDA has granted Fast Track designation for tirzepatide for weight loss. The Fast Track designation will expedite the review of tirzepatide for weight loss. FDA review will be based primarily on results from two Phase 3 clinical trials: SURMOUNT-1, which is complete, and SURMOUNT-2, which is expected to complete by the end of April 2023.
Davitkov noted, “The results are great, so I am sure it will get approved in no time.” He explained how the authors will update the guidelines in a couple of years with the hope of including new medications in the list of recommended weight-loss drugs.
The guideline notes that it is a living document and will be updated regularly as new information accumulates. More options for weight-loss drugs will allow providers to tailor the appropriate medication to each person’s specific comorbidities, values, and preferences.
To learn more about weight-loss medications and lifestyle changes, read our articles:
Weight Loss, Keeping Lost Pounds Off – Is there a Recipe for Success?