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Medications for Obesity: A Review
Kimberly A Gudzune1,2, Robert F Kushner3,4
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA
|July 22, 2024
Summary
Antiobesity medications (AOMs) are effective treatments for weight loss and improving health outcomes in obese individuals. Different AOMs offer varying degrees of weight loss and have distinct side effect profiles.
Area of Science:
- Pharmacology and Endocrinology
- Metabolic Diseases
- Clinical Therapeutics
Background:
- Obesity is a global health concern affecting millions, increasing the risk of type 2 diabetes, hypertension, and dyslipidemia.
- Antiobesity medications (AOMs) are crucial for managing obesity by targeting biological processes related to appetite and metabolism.
- AOMs are recommended as adjuncts to lifestyle interventions for enhanced weight loss and improved cardiometabolic health.
Purpose of the Study:
- To review the efficacy and adverse effects of various antiobesity medications.
- To compare the relative potency of different AOMs based on meta-analyses of randomized clinical trials.
- To inform clinical practice regarding the use of AOMs in conjunction with lifestyle modifications.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing AOMs to placebo.
- Classification of AOMs based on their mechanisms of action: digestive tract absorption modification, central appetite regulation, and nutrient-stimulated hormone mimicry.
- Analysis of reported weight loss percentages and common adverse effects for each medication class.
Main Results:
- Orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, semaglutide, and tirzepatide demonstrated significant weight loss compared to placebo.
- Weight loss efficacy varied by medication, with semaglutide (11.4%) and tirzepatide (12.4%) showing the highest percentages in meta-analyses.
- Adverse effects differed by drug class, including gastrointestinal issues with orlistat and central nervous system effects or gastrointestinal issues with other agents.
Conclusions:
- Antiobesity medications are valuable tools for managing obesity and associated comorbidities.
- The choice of AOM should consider efficacy, mechanism of action, and patient-specific adverse effect profiles.
- Integrating AOMs with lifestyle interventions offers a comprehensive strategy for effective obesity management and improved patient outcomes.
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