THE MANAGEMENT OF OBESITY is a multifaceted endeavor. Diet, exercise, and behavioral modification are all recommended, in addition to pharmacotherapy when indicated (i.e., individuals with BMI ≥ 27 kg/m2 with comorbidity or BMI ≥ 30 kg/m2) or surgical intervention when indicated (i.e., individuals with BMI ≥ 35 kg/m2 with comorbidity or BMI ≥ 40 kg/m2). Unfortunately, a number of medications can actually contribute to weight gain. Alternatives to these medications may need to be considered, especially for patients who are overweight or obese with diabetes, cardiovascular disease, or other obesity-related complications. New obesity guidelines will increase awareness about medications that can lead to significant weight gain and possible alternatives.
ATYPICAL ANTIPSYCHOTICS. These are some of the worst offenders especially olanzapine (Zyprexa, etc) or clozapine (Leponex). About one-third of patients using olanzapine gain more than 7% of their original body weight. For less weight gain consider, aripiprazole (Abilify), paliperidone (Invega), lurasidone (Latuda), asenapine (Saphris), or possibly ziprasidone (Geodon, etc).
- NOTE: Aripiprazole (Abilify) available in Egypt while paliperidone (Invega), lurasidone (Latuda), asenapine (Saphris), or possibly ziprasidone (Geodon) are NOT available.
ANTIEPILEPTICS. Up to half of patients on valproic acid (Depakene) and about one-fourth of patients using gabapentin (Gaptin) will gain ≥ 10%. When appropriate, consider a more weight-neutral option such as lamotrigine (Lamictal), phenytoin (Epanutin), or levetiracetam (Tiratam). Keep in mind that topiramate (Topamax) or zonisamide (Convagran) can lead to weight LOSS an average of 15 lbs (~7 kg) in 6 months.
ANTIDEPRESSANTS. Patients gain an average of 6 lbs on mirtazapine (Remeron) or paroxetine (Seroxate). For a more weight-neutral SSRI, consider fluoxetine (Prozac), sertraline (Lustral), citalopram (Cipram), or escitalopram. Or consider bupropion (Abstain), it may lead to about a 6 lb weight LOSS.
DIABETES MEDICATIONS. Patients gain an average of 5 lbs with glipizide (Minidiab), glyburide, or pioglitazone (Actos) or about 8 to 15 lbs with insulin. To reduce weight gain due to insulin, consider adding metformin (Glucophage), a GLP-1 agonist (liraglutide, etc), or pramlintide if appropriate.
REFERENCES
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Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, Ryan DH, Still CD; Endocrine Society. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100(2):342-62. Available at: https://pubmed.ncbi.nlm.nih.gov/25590212
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023. Available at: https://pubmed.ncbi.nlm.nih.gov/24239920