Guideline suggests prescription medications when lifestyle change ineffective for weight loss

Patients with obesity should use recently approved medications when lifestyle changes haven't been sufficient to manage their condition, according to a new guideline from the American Gastroenterological Association (AGA).

The guideline, published Oct. 20 in Gastroenterology, includes nine recommendations. In the first, the AGA recommended adding pharmacological agents to lifestyle interventions over continuing lifestyle interventions alone in adults with obesity or overweight with weight-related complications who have an inadequate response to lifestyle interventions (strong recommendation, moderate-certainty evidence).

The next four recommendations (all conditional, based on moderate-certainty evidence) suggested use of medications in adults with obesity or overweight with weight-related complications: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, or naltrexone-bupropion ER, which the guideline notes have been associated with weight loss percentages of 10.8%, 4.8%, 8.5%, and 3.0%, respectively. The AGA suggested against orlistat (conditional recommendation, moderate certainty).

The AGA suggested two other drugs for use with lifestyle interventions in conditional recommendations based on low certainty: phentermine and diethylpropion. The guideline panel identified use of Gelesis100 superabsorbent hydrogel as a knowledge gap.

While the guideline is similar to previous ones, it adds recently approved weight loss drugs that weren't available at the time in previous guidelines on overweight and obesity, the authors noted. “Naturally, given the rapid advances in this field, particularly with anti-obesity pharmacotherapy, this report bridges some gaps in the contemporary literature,” the guideline stated.