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444 Obesity- Pharmacotherapy

≥30 kg/m ), after taking into account age, gender, complications that can be ameliorated by weight loss.
2
ethnicity, fluid status, and muscularity; therefore, Pharmacotherapy should be offered to patients with
clinical evaluation and judgment must be used when obesity, when potentialbenefits outweigh the risks.
BMI is employed as the anthropometric indicator of Short-term treatment (3-6 months) using weight-loss
excess adiposity, particularly in athletes and those medications has not been demonstrated to produce
with sarcopenia.
long term health benefits and cannot be generally
At a defined BMI, the pattern of fat distribution can recommended based on scientific evidence.
vary substantially. This has been most impressively Clinicians should consider differences in efficacy, side
shown using computed tomography (CT) or magnetic effects, cautions, and that characterize medications
resonance imaging (MRI) scans which are the only approved for chronic management of obesity, as well
imaging techniques to provide a direct assessment as the presence of weight-related complications and
of the size of the intra-abdominal visceral adipose medical history.
tissue.
Treatment is individualized based weight-loss
For practical means, waist circumference provides pharmacotherapy; a generalizable algorithm for
a simple anthropometric measure to assess the fat medication preferences that would be applicable to
distribution pattern. This variable has been used in all patients cannot currently be scientifically justified.
many cross-sectional and longitudinal studies; the
waist circumference is closely correlated with BMI Combinations of FDA-approved weight-loss
but cannot discriminate between subcutaneous and medications should only be used in a manner
intra-abdominal fat depots. Due to this limitation, approved by the FDA.
there is growing clinical interest for more precise There is lack of clinical trials with head to head direct
imaging methods to obtain a better insight into comparing the drugs approved for weight loss.
intra-abdominal and ectopic fat deposition (visceral
fat, hepatic fat) in order to improve individual risk Current /Fda Approved Anti-Obesity Drugs
assessment.
The approval criteria for antiobesity drugs as set out
Table 1 Obesity classification based on BMI [data by the US FDA were revised in 2007[4] necessitating
from WHO] a 5% or more mean placebo-subtracted weight loss
after 1 year of therapy or a minimum of 35% of
participants achieving more than 5% weight loss.
Weight BM Disease Risk The European Medicines Agency (EMA) guidelines
Under weight <18.5 similarly require a 10% or more weight loss over 1 year,
which should be more than 5% above that achieved
Normal 18.5 – 24.9 Normal by placebo [5] Of note, both agencies also call for

Over Weight 25.0 – 29.9 Increase evidence of improvements in metabolic comorbidities
as these are known to affect the cardiovascular risk
Obesity more than weight loss alone.
Class I 30.0 – 34.9 Heigh Medications for weight loss approved by the Food
Class II 35.0 – 39.9 Very heigh and Drug Administration (FDA) since 2012
Class III > 40 Extremely heigh Table 2.
Current US FDA approved drugs for Obesity

Pharmacotherapy For Overweight And • Phentermine–topiramate ER (extended release),
Obesity • Lorcaserin,

Pharmacotherapy should be used only as an adjunct • Naltrexone–Bupropion
to lifestyle therapy and not alone. • Liraglutide.
Addition of pharmacotherapy produces greater • Orlistat, an intestinal lipase inhibitor that was ap-
weight loss and weight loss maintenance compared proved in 1999
with lifestyle therapy alone. The efficacy and side-effect profiles of these

Lifestyle therapy and pharmacotherapy should medications, when used as adjuncts to lifestyle
be considered in patients with weight-related

GCDC 2017