New guidelines will encourage using weight loss drugs to control obesity and weight-related conditions in some patients. We know that lifestyle changes are still first-line and adding medications may help patients adhere to their diet. But weight loss medications don't always work and there's no proof yet that they improve long-term outcomes.
Expect about one in 2 patients to have at least a 5% weight loss on Qsymia (NOT available in Egypt) after one year, and just one in 4 or 5 patients with Saxenda, Contrave, Belviq, or orlistat. Saxenda and orlistat, both are available in Egyptian community pharmacies. Save weight loss medications for patients with a BMI ≥ 30 or ≥ 27 with a weight-related condition (diabetes, hypertension, etc). In general, stop the medication if a patient doesn't lose ≥ 5% of body weight after 12 weeks on maximum doses. Use this table to help compare options...
| Table (1). Medications for Weight Loss | |||
|---|---|---|---|
| Drug | ~ Weight Loss VS Placebo at 1 year | Stopped Due to Side Effects | Possible Drawbacks and Considerations |
| Qsymia (phentermine/ topiramate ER) |
9 kg (19 lbs) |
1 in 12 at highest dose |
Impaired cognition, metallic taste, paresthesia Monitor heart rate |
| Saxenda (liraglutide) | 5.4 kg (12 lbs) | 1 in 18 | Nausea, rare hypoglycemia |
| Contrave (naltrexone/ bupropion ER) |
4 kg (9 lbs) | 1 in 9 | Nausea, seizures Avoid with opioids, seizure disorders, and uncontrolled hypertension |
| Belviq (lorcaserin) | 3.5 kg (8 lbs) | 1 in 53 | Dizziness, fatigue Be careful with other serotonergic drugs |
| Orlistat (Xenical) | 3 kg (7 lbs) | 1 in 26 | Nausea, diarrhea, fecal urgency Avoid in cholestasis, chronic malabsorption |
| Phentermine | 2 kg (5 lbs) | 1 in 9 | Agitation, insomnia Avoid in heart disease, uncontrolled BP |
| NOTE: Saxenda and orlistat are available in Egypt, other are not available. | |||
Also watch for medications that can lead to significant weight GAIN, such as; olanzapine (Olapex), gabapentin (Conventin), paroxetine, sulfonylureas (Amaryl), etc. Use our NOTE, "Consider alternatives to medications that can lead to significant weight gain", for alternatives. And get our GUIDANCE, "7 Diet, a professional guide for weight loss", INCLUDE 7 STEPS WHICH ARE designed for clinical nutritionists to help overweight and obese patients, it also contains a full chart of weight loss medications. Read our note, "New products to try to lose weight", to get more data about weight LOSS medications which are available in Egypt.
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://academic.oup.com/jcem/article/100/2/342/2813109?login=false
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://www.sciencedirect.com/science/article/pii/S0735109713060300?via%3Dihub
Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. Available at: https://jamanetwork.com/journals/jama/fullarticle/1774038