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MEDICATIONS for the TREATMENT of OBESITY NASMHPD MEDICAL DIRECTORS BEST PRACTICES SYMPOSIUM LAURENCE H. MILLER, MD
Overview • Obesity is a chronic disease despite the cultural conviction that medications are inappropriate for obesity management.
BMI • Prescription weight lost drugs are approved only for those with a body mass index (BMI) of 30 or above Or • 27 and above if they have obesity-related conditions such as high blood pressure, dyslipidemia or type 2 diabetes. • BMI of 18.5 – 24.9 is healthy.
Why Medications? • Medications are used to establish control and to sustain that control. • Weight loss medications lead to an average weight loss of 5-22 pounds more than what you might lose with non-drug obesity treatments.
Parameters of Use • If a patient does not lose at least 4 pounds over 4 weeks on a particular medication, then that medication is unlikely to help the patient achieve significant weight loss.
Studies • There are very few studies lasting more than 2 years evaluating the safety or effectiveness of weight loss medications.
Benefits of Medications • Maximum weight loss usually occurs within 6 months of starting medication treatment. • Weight tends to level off or increase during the remainder of treatment.
Benefits of Medications • Over the short term, weight loss in obese individuals may reduce a number of health risks.
Potential Risks • Potential for abuse or dependence since most medications except Orlistat are controlled substances. • Development of tolerance • Side effects might outweigh benefits because weight loss medications are used to treat a condition that affects millions of people, many of whom are basically healthy.
Support Services • Patients tend to use support services more frequently when they are losing weight and then rely entirely on their relationship with their physician alone for the continuing use of the medication for the maintenance of their weight loss.
Specific Medications • Appetite Suppressants – decrease appetite or increase feeling of being full by norepinephrine, serotonin and dopamine reuptake inhibition • Phentermine (Adipex-P) • Side effects • Sleeplessness, nervousness, euphoria • Sibutramine (Meridia) • Side effects • increase in blood pressure and heart rate
Specific Medications • Diethylpropion (Tenuate) • Mazindol (Sanorex, Mazanor) • Phendimetrazine (Bontril) • Side effects • increase in blood pressure and heart rate
Specific Mediations • Lipase Inhibitors – decrease the body’s ability to absorb dietary fat by 1/3 by blocking the enzyme lipase which breaks down dietary fat. Diet must contain less than 30% fat. • Orlistat (Xenical) • Side effects • cramping, discomfort, gas, diarrhea, oily stools
Bottom Line • The treatment of obesity should not only include medications but also: • diet • exercise • support activities