Exposure to GLP-1 Receptor Agonist and Bariatric Surgery Use on Obesity Policy Support.

BACKGROUND: Glucagon-like-peptide-1 receptor agonists (GLP-1s) are a newer class of obesity medications that have garnered significant attention by the public and media. Media reports suggest that medical interventions such as GLP-1s are often perceived as weight loss "shortcuts." PURPOSE: The present experimental research tested the effect of exposure to medical weight loss interventions on GLP-1 policy support, dependent on body mass index. METHODS: A sample of 440 participants (Mage  = 37, SD = 12.6) were randomly assigned to read about a woman who lost 15% of her body weight either with a GLP-1, bariatric surgery, or diet/exercise. Participants reported on beliefs that the woman took a weight loss "shortcut" and support for three policies expanding GLP-1 coverage. RESULTS: Exposure to a woman who lost weight with GLP-1 or bariatric surgery (vs. diet/exercise) led to higher GLP-1 policy support. However, such exposure was also indirectly associated with lower policy support, partially mediated by weight loss "shortcut" beliefs. CONCLUSIONS: This study provides evidence that exposure to medical weight loss interventions leads to higher GLP-1 policy support. Exposure may also, indirectly, lead to lower policy support due to beliefs that such interventions are shortcuts. Findings have implications for policymakers who are interested in how perceptions of medical weight loss interventions influence support for obesity treatments and related health policies.

Media reports suggest that medical interventions to treat obesity, such as GLP-1 agonists, are often perceived as weight loss "shortcuts" or "taking the easy way out." This experimental study tested the effect of exposure to medical weight loss interventions on support for GLP-1 policies, dependent on participant body mass index. A sample of 440 participants were randomly assigned to read about a woman who lost 15% of her body weight either with a GLP-1, bariatric surgery, or diet/exercise. Then participants reported on beliefs that the woman took a weight loss "shortcut" and support for three policies expanding GLP-1 coverage. Results showed that exposure to a woman who lost weight with GLP-1 or bariatric surgery, compared to diet/exercise, led to higher GLP-1 policy support. However, such exposure was also indirectly associated with lower GLP-1 policy support due to higher weight loss "shortcut" beliefs. Findings have implications for policymakers who are interested in how perceptions of medical weight loss interventions influence support for obesity treatments and related health policies.

Debating Weight Loss vs. Weight Neutral Strategies for Improvements of Health.

PURPOSE OF REVIEW: Despite decades of development and testing of weight-loss interventions, the adult populations worldwide have witnessed a continuous rise in body weight. There is an ongoing debate about how to move forward. Some argue that this rise calls for more intensive and possibly life-long treatments, including the new effective GLP1 weight loss medications, while others have called for a fundamental shift away from weight and on to a broader understanding of health. The two strategies are represented as a weight-centric health strategy and a weight neutral health strategy. This paper debates the benefits and potential harms related to the use of these two strategies. RECENT FINDINGS: While major weight loss may have substantial health benefits, many individuals will need intensive treatment including weight loss medication to achieve it, as generally few are able to sustain a lifestyle induced weight loss in the long term. Both the weight loss and the weight-neutral health strategies have advantages and limitations emphasizing the need for further research comparing the two strategies. Currently, not everyone is offered, can afford, will tolerate or even desire treatment with weight loss medication, and weight neutral health strategies may be a desirable alternative intervention offering a more holistic approach to health and addressing psychological and social issues including the burden of experienced and internalized weight stigma. However, this method still needs to be tested for effectiveness with regards to both physical and long-term psychological benefits.

Managing the new wave of weight loss medication in general practice: A qualitative study.

In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.

A pilot randomized controlled trial of liraglutide 3.0 mg for binge eating disorder.

Objective: To assess the efficacy of liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) receptor agonist, for binge eating disorder (BED). Methods: Adults with a body mass index (BMI) ≥ 27 kg/m2 enrolled in a pilot, 17-week double-blind, randomized controlled trial of liraglutide 3.0 mg/day for BED. The primary outcome was number of objective binge episodes (OBEs)/week. Binge remission, weight change, and psychosocial variables were secondary outcomes. Mixed effect models were used for continuous variables, and generalized estimating equations were used for remission rates. Results: Participants (n = 27) were 44.2 ± 10.6 years; BMI = 37.9 ± 11.8 kg/m2; 63% women; and 59% White and 41% Black. At baseline, the liraglutide group (n = 13) reported 4.7 ± 0.7 OBEs/week, compared with 3.0 ± 0.7 OBEs/week for the placebo group, p = 0.07. At week 17, OBEs/week decreased by 4.0 ± 0.6 in liraglutide participants and by 2.5 ± 0.5 in placebo participants (p = 0.37, mean difference = 1.2, 95% confidence interval 1.3, 2.0). BED remission rates of 44% and 36%, respectively, did not differ. Percent weight loss was significantly greater in the liraglutide versus the placebo group (5.2 ± 1.0% vs. 0.9 ± 0.7%, p = 0.005). Conclusion: Participants in both groups reported reductions in OBEs, with the liraglutide group showing clinically meaningful weight loss. A pharmacy medication dispensing error was a significant limitation of this study. Further research on liraglutide and other GLP-1 agonists for BED is warranted.

Use of weight loss medications in relation with prostate, colorectal and male breast cancers among older men: SEER-Medicare 2007-2015.

BACKGROUND: The association of weight loss medications with prostate (PCa), colorectal (CRC) or male breast cancers, including assessment of these cancers combined (HRCs, hormone-associated cancers) remain poorly understood. Testosterone replacement therapy (TTh) is reported to be inversely associated with obesity, PCa and CRC, but it is unclear whether TTh modifies the association of weight loss medications with HRCs. METHODS: In 49,038 men (≥ 65 years) of SEER-Medicare, we identified 15,471 men diagnosed with PCa, 4836 with CRC, and 141 with male breast cancers. Pre-diagnostic prescription of weight loss medications and TTh was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards (mortality) models were conducted. RESULTS: We found an inverse association between use of weight loss medications and incident PCa (OR 0.59, 95% CI 0.57-0.62), CRC (OR 0.86, 95% CI 0.80-0.92), and HRCs (OR 0.65, 95% CI 0.62-0.68). Similar associations were observed for advanced stage at diagnosis of PCa and CRC. Effects of weight loss medications on PCa and HRC remained significant irrespective of the use of TTh but were only suggestive with CRC with positive TTh use. No associations were observed with male breast cancer and HRCs mortality. CONCLUSION: Pre-diagnostic use of weight loss medications reduced the incidence of PCa, CRC, and HRCs. These associations persisted in the same direction irrespective of the history of TTh use. Future studies are needed to confirm these findings and to identify underlying biological mechanisms of weight loss medications and TTh on the risk of cancer.

A systematic review of licensed weight-loss medications in treating antipsychotic-induced weight gain and obesity in schizophrenia and psychosis.

BACKGROUND: Schizophrenia and antipsychotic use are associated with clinically significant weight gain and subsequent increased mortality. Despite weight loss medications (WLMs) licensed by regulatory bodies (FDA, EMA, and MHRA) being available, current psychiatric guidelines recommend off-label alternatives, which differ from non-psychiatric guidelines for obesity. OBJECTIVE: Evaluate the efficacy of licensed WLMs on treating antipsychotic-induced weight gain (AIWG) and obesity in schizophrenia and psychosis (OSP). METHOD: A literature search was conducted using Medline, EMBASE, PsycINFO and Cochrane Library online databases for human studies using licensed WLMs to treat AIWG and OSP. RESULTS: Three RCTs (two liraglutide, one naltrexone-bupropion), one unpublished open-label trial (naltrexone-bupropion), and seven observational studies (five liraglutide, one semaglutide, one multiple WLMs) were identified. Results for liraglutide showed statistically significant improvement in weight, BMI, waist circumference, HbA1c, cholesterol, and LDL readings on meta-analysis. Evidence was mixed for naltrexone-bupropion with no detailed studies conducted for setmelanotide, or stimulants. CONCLUSION: Evidence is strongest for liraglutide compared to other licensed WLMs. The findings, particularly the inclusion of human trial data, provide evidence for liraglutide use in treating AIWG and OSP, which would better align psychiatric practice with non-psychiatric practices around obesity. The findings also identify continued literature gaps regarding other licensed WLMs.

Effectiveness and Safety of Liraglutide in Managing Inadequate Weight Loss and Weight Regain after Primary and Revisional Bariatric Surgery: Anthropometric and Cardiometabolic Outcomes.

BACKGROUND: No study appraised the effectiveness and safety of liraglutide in managing inadequate weight loss or weight regain (IWL/ WR) after primary versus revisional bariatric surgery (BS). METHODS: Retrospective study of all eligible adults who completed liraglutide 3 mg therapy for IWL/WR after primary or revisional BS at our institution between May 2016 and June 2019 (N = 145; 119 primary, 82%; 26 revisional, 18%). Changes in anthropometric and cardiometabolic parameters were assessed before the start of liraglutide and at 6 and 12 months after treatment. RESULTS: The mean age was 43.32 ± 10.49 years, and 83% were females. Patients received liraglutide at a mean of 54.10 ± 31.75 months after their BS, for WR (74.3%) or IWL (25.6%). Liraglutide significantly reduced weight and BMI among primary and revisional patients (P < 0.0001 for all) and was equally effective in these reductions for both groups. Primary patients achieved total weight loss percentage (TWL%) of 5.97% and 6.93% at 6 and 12 months. Additionally, 52.3% and 60% of the patients lost ≥ 5% of their total weight (TW) at 6 and 12 months after primary BS. Revisional patients achieved TWL% of 6.41% and 4.99% at 6 and 12 months, and 60% and 48% of patients lost ≥ 5% TW at the two time points. Liraglutide did not improve cardiometabolic outcome for primary patients; for revisional patients, only the systolic blood pressure decreased after treatment. Liraglutide was well tolerated, and the most common side effect was nausea. CONCLUSIONS: Liraglutide is useful as an adjunct weight loss medication for patients achieving unsatisfactory outcomes with BS.

Patterns of Weight Loss Medication Utilization and Outcomes Following Bariatric Surgery.

BACKGROUND: Bariatric surgery is the most effective treatment for obesity; however, some patients experience significant weight regain. Weight loss medications (WLM) are being increasingly used in surgery patients with limited evidence. We examine weight loss outcomes in patients using WLM after bariatric surgery. METHODS: In a retrospective study, 197 bariatric surgery patients who started WLM between 2016 and 2019 at a single center were analyzed. Patients were categorized into 3 groups based on outcomes of the initial surgery: (1) Weight regainers (WR) = achieved goal weight loss after surgery (15% total body weight loss (TBWL) for sleeve gastrectomy (SG) and 25% TBWL for Roux-en-Y gastric bypass (RYGB)) with subsequent regain of > 20% of weight lost; (2) Adequate weight loss (AWL) = achieved goal weight loss without > 20% weight regain; (3) Non-responders (NR) = never achieved goal weight loss. Weight loss and medication use patterns were analyzed. RESULTS: Among the three categories, there was no significant difference in duration of medical therapy or %TBWL with medications. RYGB patients lost more weight than SG patients using WLM (p = 0.03). Of the medications used, patients treated with phentermine + topiramate had the highest likelihood of achieving 5%, 10%, and 15% weight loss. Compared to other 2 groups, AWL group initiated WLM earlier and experienced more weight loss when compared to their pre-operative weight or post-operative nadir. CONCLUSIONS: RYGB patients respond better to WLM than SG patients. Those who had started WLM before regaining weight (AWL) experienced greater overall weight loss, suggesting that proactive medical therapy at the time of weight plateau can help with greater total weight loss. Phentermine + topiramate is the most effective WLM in post-bariatric surgery patients.

A Practical Approach to Assist Asthmatics to Lose Weight.

Treating patients with obesity, particularly asthmatics, is a complex challenge that requires a unique and individually tailored approach. Obesity, defined by the Centers for Disease Control and Prevention, is a body mass index of 30.0 kg/m2 or greater. It affects approximately 43% of adults and 19% of youth in America. It is a multifactorial disease and should be managed with the same intensity as any other medical problem, for it represents a risk factor for the onset and severity of asthma. Furthermore, it is a comorbid condition that exacerbates rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea, hypertension, anxiety, and depression. Being obese also increases morbidity for cardio/cerebrovascular diseases, metabolic syndrome, type 2 diabetes, breast and bladder cancer, and migraines. Osteoarthritis, in particular, of the knees and hips, is also associated with obesity, and that too will complicate asthma by hindering a subject's mobility and ability to exercise. This paper reviews the epidemiology and pathophysiology of obesity, its effect on asthma, and practical strategies to achieve weight loss.

Trends in prescribing anti-obesity pharmacotherapy for paediatric weight management: Data from the POWER Work Group.

INTRODUCTION: To better inform the field of obesity medicine, we set out to describe the current use of pharmacotherapy meant to improve patient weight status among a group of clinicians connected through the Paediatric Obesity Weight Evaluation Registry (POWER), as well as reasons behind clinicians' use or non-use of the medications. METHODS: Paediatric weight management (PWM) programs participating in POWER were asked to complete a program profile survey in 2014 (n = 30) and 2017 (n = 33); questions about pharmacotherapy use were included. Descriptive statistics were used to identify: (a) the proportion of PWM programs offering obesity pharmacotherapy; (b) the medications most commonly prescribed; and (c) reasons among non-prescribers for not offering pharmacotherapy. RESULTS: The 2014 and 2017 surveys were completed by 29 PWM programs (97%) and 30 PWM programs (91%), respectively. Twenty-one programs completed both surveys. In 2014, 10 (34%) programs reported offering pharmacologic agents specifically for weight control, whereas in 2017, 16 (53%) reported offering pharmacotherapy for a primary indication of weight loss. Metformin was reported as the most commonly used agent in 2014, and topiramate in 2017. Largest reported increases in use over time were for topiramate and phentermine. DISCUSSION: Our survey results demonstrate that a majority of this group of PWM programs offered pharmacotherapy to promote weight loss in patients with complications or associated medical conditions. There was a trend indicating increasing use over time, despite the significant gap regarding pharmacotherapy use in the literature. CONCLUSIONS: These data suggest the need for (a) additional robust paediatric drug trials to further develop the evidence base guiding use or non-use of pharmacotherapy in paediatric weight management, and (b) increased understanding of both facilitators and barriers to prescribing anti-obesity pharmacotherapy for youth with obesity.

Effect of Weight Loss Medications on Hepatic Steatosis and Steatohepatitis: A Systematic Review.

Non-alcoholic fatty liver disease (NAFLD) is a common comorbidity in individuals with obesity. Although multiple pharmacotherapeutics are in development, currently there are limited strategies specifically targeting NAFLD. This systematic review summarizes the existing literature on hepatic effects of medications used for weight loss. Glucagon-like peptide 1 (GLP-1) agonists are the best-studied in this regard, and evidence consistently demonstrates reduction in liver fat content, sometimes accompanied by improvements in histological features of steatohepatitis and reductions in serum markers of hepatic injury such as alanine aminotransferase (ALT). It remains unclear whether these benefits are independent of the weight loss caused by these agents. Literature is limited regarding effects of orlistat, but a small number of reports suggest that orlistat reduces liver fat content and improves histologic features of NASH, benefits which may also be driven primarily by weight loss. A sizeable body of literature on hepatic effects of metformin yields mixed results, with a probability of modest benefit, but no consistent signal for strong benefit. There are insufficient data on hepatic effects of topiramate, phentermine, naltrexone, bupropion, and lorcaserin. Finally, a few studies to date suggest that sodium-glucose co-transporter-2 (SGLT2) inhibitors may reduce liver fat content and cause modest reductions in ALT, but further study is needed to better characterize these effects. Based on available data, GLP-1 agonists have the strongest evidence base demonstrating beneficial effects on NAFLD, but it is not clear if any weight loss medication has effects on NAFLD superior to those of nutritional modification and exercise alone.

Weight Loss Medications in the Treatment of Obesity and Hypertension.

PURPOSE OF REVIEW: Weight loss is strongly associated with improvement in blood pressure; however, the mechanism of weight loss can impact the magnitude and sustainability of blood pressure reduction. RECENT FINDINGS: Five drugs-orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion-are currently approved for weight loss therapy in the USA. Naltrexone/bupropion results in an increase in in-office and ambulatory blood pressure compared to placebo. Other therapies are associated with modest lowering of blood pressure, and are generally well-tolerated; nonetheless, evidence is limited regarding their effect on blood pressure, particularly longitudinally, in individuals with hypertension. Although weight loss medications can be an effective adjunct to lifestyle modifications in individuals with obesity, there is limited evidence regarding their benefit with regard to blood pressure. Future studies evaluating the effectiveness of weight loss medications should include careful assessment of their short- and long-term impact on blood pressure in individuals with hypertension.

Use of Lisdexamfetamine to Treat Obesity in an Adolescent with Severe Obesity and Binge Eating.

Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12⁻19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or extreme childhood obesity, many children in weight management programs do not achieve a healthy weight. Most often, these patients will go on to require metabolic and bariatric surgery (MBS), but challenges and limitations may prohibit MBS on adolescents. Thus, tertiary care pediatric weight management centers are compelled to treat select pediatric obesity subtypes presenting with disease progression and disability with the available adult FDA-approved therapeutic modalities, specifically pharmacotherapy, in order to alleviate the disease state and provide relief to the patient. Here, we describe a case of severe pediatric obesity where a dedicated multidisciplinary pediatric weight management team at a tertiary care center utilizes a progressive pharmacotherapeutic approach with enormous benefits to the patient, highlighting the urgent gap and clinical care needs of this special population niche of severe adolescent obesity.

Incremental cost-effectiveness of evidence-based non-surgical weight loss strategies.

Recent medical advancements have led to new modes of treatment for non-surgical weight loss, including several new medications. Our aim was to conduct an incremental cost-effectiveness analysis for all commercially available, evidence-based non-surgical weight loss interventions for people with excess weight. We identified interventions through a systematic review of randomized controlled trials that reported weight loss 12 months from baseline. We then meta-analysed the results, sourced costs and performed an incremental cost-effectiveness analysis from the payer perspective. Cost-effectiveness was presented in terms of cost per kilogram lost and quality-adjusted life years (QALY) gained. We further performed sensitivity analyses on costs and duration of benefits, and a probabilistic sensitivity analysis. Ten interventions were identified for inclusion: six pharmaceutical products (Alli, Xenical, Qsymia, Contrave, Belviq and Saxenda), two lifestyle modification programmes (Weight Watchers Meetings and Online), one food replacement and lifestyle programme (Jenny Craig) and one intragastric balloon system (Orbera). At an incremental cost-effectiveness ratio of $30 071 per additional QALY gained, only Weight Watchers Meetings was cost-effective. Sensitivity analyses revealed that for the medications to become incrementally cost-effective, costs would have to decrease by as much as 91%. Results are highly dependent on duration that benefits are maintained. Despite several newly available interventions, Weight Watchers Meetings is currently the only evidence-based, commercially available, cost-effective option for non-surgical weight loss. Other interventions, specifically medications, are more effective but priced too high to be cost-effective.

When to Initiate Weight Loss Medications in the NAFLD Population.

Nonalcoholic fatty liver disease (NAFLD) is characterized by histological evidence of hepatic steatosis, lobular inflammation, ballooning degeneration and hepatic fibrosis in the absence of significant alcohol use and other known causes of chronic liver diseases. NAFLD is subdivided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL is generally benign but can progress to NASH, which carries a higher risk of adverse outcomes including cirrhosis, end-stage liver disease, hepatocellular carcinoma and death if liver transplantation is not pursued in a timely fashion. Currently, lifestyle modifications including healthy diet and increased physical activity/exercise culminating in weight loss of 5% to >10% is the cornerstone of treatment intervention for patients with NAFLD. Patients with NAFLD who fail to obtain this goal despite the help of dietitians and regimented exercise programs are left in a purgatory state and remain at risk of developing NASH-related advance fibrosis. For such patients with NAFLD who are overweight and obese, healthcare providers should consider a trial of FDA-approved anti-obesity medications as adjunct therapy to provide further preventative and therapeutic options as an effort to reduce the risk of NAFLD-related disease progression.

Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study.

Weight loss medications are effective to confer additional weight loss after bariatric surgery in the general population, but they have not been evaluated in adults 60 years of age and older. We performed a retrospective study identifying 35 patients who were ≥60 years old and had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2000 to 2014, and were subsequently prescribed weight loss medications. Linear regression analyses were performed to determine beta coefficients of certain predictor variables being associated with weight loss. Patients lost weight on medications with an average body mass index (BMI) change of -2.74 kg/m2, standard deviation = 2.6 kg/m2. RYGB patients lost a greater percentage of BMI on medication than SG (SG; -1.38 ± 1.49 kg/m2 and RYGB; -3.37 ± 2.83 kg/m2, p = 0.0372). Patients with hypertension were less likely to lose weight on medications (ß = 16.76, p = 0.004, and 95% confidence interval = 5.85-27.67). Weight loss medications are a useful treatment to confer additional weight loss in adults 60 years of age and older after RYGB and SG.

Weight loss medications in Canada - a new frontier or a repeat of past mistakes?

Current methods for the treatment of excess weight can involve healthy behavior changes, pharmacotherapy, and surgical interventions. Many individuals are able to lose some degree of weight through behavioral changes; however, they are often unable to maintain their weight loss long-term. This is in part due to physiological processes that cannot be addressed through behavioral changes alone. Bariatric surgery, which is the most successful treatment for excess weight to date, does result in physiological changes that can help with weight loss and weight maintenance. However, many patients either do not qualify or elect to not have this procedure. Fortunately, research has recently identified changes in neurochemicals (i.e., orexigens and anorexigens) that occur during weight loss and contribute to weight regain. The neurochemicals and hormones may be able to be targeted by medications to achieve greater and more sustained weight loss. Two medications are approved in adjunction to lifestyle management for weight loss in Canada: orlistat and liraglutide. Both medications are able to target physiological processes to help patients lose weight and maintain a greater amount of weight loss than with just behavioral modifications alone. Two other weight management medications, which also target specific physiological processes to aid in weight loss and its maintenance, a bupropion/naltrexone combination and lorcaserin, are currently pending approval in Canada. Nonetheless, there remain significant barriers for health care professionals to prescribe medications for weight loss, such as a lack of training and knowledge in the area of obesity. Until this has been addressed, and we begin treating obesity as we do other diseases, we are unlikely to combat the increasing trend of obesity in Canada and worldwide.

Treatment satisfaction with different weight loss methods among respondents with obesity.

Satisfaction with weight loss (WL) methods has been correlated with the effectiveness, long-term compliance and commitment to weight management. This study explored treatment satisfaction associated with different WL methods among patients with obesity. Cross-sectional data were analysed from the 2012 US National Health and Wellness Survey. Respondents with obesity were categorized as having a WL procedure (e.g., gastric bypass and gastric banding) or using a prescription medication for WL (Sur/Rx), vs. using self-modification WL techniques (e.g., diet, exercise and WL supplements). Overall satisfaction with current WL methods was assessed among the obese and the overweight/obese with type 2 diabetes mellitus (T2DM). Of the 22 927 respondents with obesity, 58.4% took no current action to lose weight, 2.3% were identified as Sur/Rx and 39.3% were identified as self-modification. The Sur/Rx group reported being very/extremely satisfied more frequently than the self-modification group (39.3% vs. 20.2%, P < 0.001). Similarly, respondents with T2DM that were overweight/obese reported higher satisfaction in the Sur/Rx vs. the self-modification group (46.6% vs. 22.7%, P < 0.001). Satisfaction with WL methods was greater for the Sur/Rx vs. the self-modification group. Data suggest the importance of including bariatric surgery and pharmacotherapy as an integral part in comprehensive WL management.

Combination phentermine and topiramate extended release in the management of obesity.

INTRODUCTION: Losing ≥ 5% of initial weight improves quality of life and risk factors for cardiovascular disease (CVD) in obese individuals. Lifestyle modification, the cornerstone of weight reduction, may be complemented by pharmacotherapy. In 2012, the FDA approved the combination of phentermine and topiramate extended release (ER) for chronic weight management, as an adjunct to lifestyle modification. AREAS COVERED: This review examines the safety and efficacy of phentermine-topiramate ER, as determined by randomized controlled trials (RCTs). A preliminary study confirmed the benefit of combining the two medications for improving weight loss and reducing adverse effects, as compared to using equivalent-dose monotherapy alone. EXPERT OPINION: Across RCTs, groups prescribed phentermine 15 mg/topiramate ER 92 mg lost an average of 10% of initial weight, ∼ 8% more than placebo and 2% more than phentermine 7.5 mg/topiramate 46 mg. Weight loss reduced the risk of developing type 2 diabetes and improved CVD risk factors. Phentermine-topiramate ER, however, was associated with increased heart rate, the clinical significance of which is being investigated in an FDA-required CVD outcomes study. The medication also must be used with caution in women of child-bearing age because of an increased risk to infants of oral cleft.