Today the American Gastroenterology Association (AGA) released new evidence-based guidelines that strongly recommend, for the first time, the long-term use of four approved anti-obesity medications for adult patients who haven’t been able to successfully lose weight through lifestyle changes alone. The new recommendations will be published in the November 2022 issue of Gastroenterology.
“There have been changes in obesity treatment in recent years. This guideline is the first since diabetes drugs were approved for obesity treatment and provides clear information for doctors and their adult patients who struggle to lose weight or keep it off with lifestyle changes alone,” said a coauthor of the findings, Perica Davitkov, MD, a professor in the department of medicine at Case Western Reserve University in Cleveland, Ohio, in a press release.
Weight Loss Medications Are First-Line Medical Options
If a person weighs more than what is considered healthy for their height, they have overweight or obesity. Body mass index (BMI) is one measurement of these conditions; it’s calculated based on a person’s weight and height, and the same formula is used for both men and women. A person with BMI from 25 to 29.9 is considered overweight, and a person with a BMI of over 30 is considered to be obese.
Weight loss medications are first-line medical options and should be used along with healthy eating and regular physical activity, according to the guidelines. Four medications have been approved and shown to result in moderate weight loss as a percentage of body weight (reported as the difference compared with a percentage of weight loss observed in the placebo group).
- Semaglutide (Wegovy) weight loss percentage: 10.8 percent
- Phentermine-topiramate ER (Qsymia) weight loss percentage: 8.5 percent
- Liraglutide (Saxenda) weight loss percentage: 4.8 percent
- Naltrexone-bupropion ER (Contrave) weight loss percentage: 3.0 percent
“These medications treat a biological disease, not a lifestyle problem,” said another author, Eduardo Grunvald, MD, of the University of California in San Diego. “Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term. Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver, and hypertension.”
People who have overweight or obesity are at an increased risk of death from any cause, as well as stroke, coronary heart disease, and many types of cancer, according to the Centers for Disease Control and Prevention (CDC).
Obesity Was First Recognized as a Disease Nearly a Decade Ago
According to the Obesity Medicine Association, the American Medical Association (AMA) designated obesity a disease in 2013. Although it is influenced by behavioral factors, experts now recognize that genetics, environment, social determinants of health, and biological factors influenced by medications, illnesses, and hormones all play a role.
The prevalence of obesity in the United States has increased dramatically from 30.5 percent to 41.9 percent over the last 20 years, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
More Americans Are Dieting, but Research Shows It’s Hard to Maintain Weight Loss
A 2020 report from the CDC found that about 17 percent of Americans report being on a diet — that’s up from 14 percent in the previous decade.
Unfortunately, research suggests that even people who successfully lose weight have a hard time keeping the pounds off. In a meta-analysis of 29 long-term weight loss studies, more than half the lost weight was regained within two years, and by five years more than 80 percent of the lost weight was regained.
Weight Loss Medications Could Slow the Obesity Epidemic
More widespread use of these medications could absolutely slow the obesity epidemic, says Fatima Cody Stanford, MD, MPH, an associate professor of medicine and pediatrics at Harvard Medical School in Boston and an obesity specialist at Massachusetts General Hospital, who was not involved in writing the new recommendations.
Dr. Stanford was the author of a paper published in December 2021 in the Mayo Clinic Proceedings that found only 1 percent of Americans who meet the criteria for weight loss medication actually receive it.
“It is important to note that this is not the case with any other chronic disease,” says Stanford. This is due in part to the misperception that obesity is a lifestyle choice rather than a disease, she says.
Who Is Eligible to Take Weight Loss Medications?
People may be prescribed a weight loss drug if they haven’t been able to lose weight through diet and exercise and meet one of the following:
- Have a BMI greater than 30
- Have a BMI greater than 27 and an obesity-related chronic disease such as type 2 diabetes, heart disease, or obstructive sleep apnea
Stanford strongly recommends the use of these medications in people who haven’t been able to lose weight through lifestyle modifications alone. “It is important to note that these medications are used chronically, which means that they will not be stopped. Many people think that they will go on the medications and come off once they reach a particular weight, but stopping the medications (if they have been effective) will only lead to weight regain,” she says.
Weight loss drugs can be expensive, and insurance coverage can vary. If you aren’t sure if the medication will be covered, call your insurance company.