Pharmacological Interventions for Adults With Obesity
Summary of Recommendations
- AOMs generally need to be used chronically, and the selection of the medication or intervention should be based on the clinical profile and needs of the patient, including, but not limited to, comorbidities, patients' preferences, costs, and access to the therapy.
- Given the magnitude of net benefit, semaglutide 2.4 mg may be prioritized over other approved AOMs for the long-term treatment of obesity for most patients.
- Semaglutide has glucoregulatory benefits and is also approved for the treatment of T2DM
- Semaglutide may delay gastric emptying with adverse effects of nausea and vomiting. Gradual dose titration may help mitigate these adverse effects.
- GLP-1 RAs have been associated with increased risk of pancreatitis and gallbladder disease
- Liraglutide has glucoregulatory benefits and is also approved for the treatment of T2DM
- Liraglutide may delay gastric emptying with adverse effects of nausea and vomiting. Gradual dose titration may help mitigate these adverse effects.
- Liraglutide has been associated with an increased risk of pancreatitis and gallbladder disease
- Because topiramate is effective for treating migraine headaches, phentermine-topiramate ER may be preferentially used in patients with comorbid migraines.
- Phentermine-topiramate ER should be avoided in patients with a history of cardiovascular disease and uncontrolled hypertension.
- Topiramate is teratogenic. Women of childbearing potential should be counseled to use effective contraception consistently.
- Blood pressure and heart rate should be monitored periodically while taking medications with phentermine.
- Naltrexone-bupropion ER may be considered for the treatment of overweight or obesity in patients who are attempting smoking cessation, and in patients with depression.
- Naltrexone-bupropion ER should be avoided in patients with seizure disorders and used with caution in patients at risk of seizures.
- Naltrexone-bupropion ER should not be used concomitantly with opiate medications.
- Blood pressure and heart rate should be monitored periodically while taking naltrexone-bupropion ER, especially in the first 12 weeks of treatment.
- Patients using orlistat should take a multivitamin daily. Vitamins should contain fat-soluble vitamins (A, D, E, K) and should be taken 2 hours apart from orlistat.
- Comment: Patients who place a high value on the potential small weight loss benefit and low value on GI adverse effects may reasonably choose treatment with orlistat.
- Phentermine monotherapy is approved by the FDA for short-term use (12 weeks). However, given the chronic nature of weight management, many practitioners use phentermine longer than 12 weeks in an off-label fashion.
- Phentermine should be avoided in patients with a history of cardiovascular disease.
- Blood pressure and heart rate should be monitored periodically while taking phentermine.
- Diethylpropion monotherapy is approved by the FDA for short-term use (12 weeks). However, given the chronic nature of weight management, many practitioners use diethylpropion longer than 12 weeks in an off-label fashion.
- Diethylpropion should be avoided in patients with a history of cardiovascular disease.
- Blood pressure and heart rate should be monitored periodically while taking diethylpropion.
Recommendation Grading
Overview
Title
Pharmacological Interventions for Adults With Obesity
Authoring Organization
American Gastroenterological Association
Publication Month/Year
October 19, 2022
Last Updated Month/Year
October 3, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Document Objectives
Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity.
Target Patient Population
Adults with overweight and obesity
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D009765 - Obesity, D019440 - Anti-Obesity Agents, D000073319 - Obesity Management
Keywords
obesity, obesity medications, adiposity
Source Citation
Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, Harindhanavudhi T, Sultan S, Singh S, Davitkov P; AGA Clinical Guidelines Committee. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. 2022 Nov;163(5):1198-1225. doi: 10.1053/j.gastro.2022.08.045. Epub 2022 Oct 20. PMID: 36273831.