Continuation of case study


John’s most recent hemoglobin (Hb)A1Cwas 7.3% and his fasting blood glucose was 117 mg/dL. His body mass index (BMI) is 
28 kg/m2, which indicatesthat he is overweight. His waist circumference is 104 cm (abdominal obesity is defined as waist circumference >102 cm/40 inches). A general physical exam, urinalysis, and blood testing are within acceptable parameters; his low-density lipoprotein (LDL) cholesterol is slightly elevated.

John has been trying to eat a low-carbohydrate diet but says that he really has not lost much weight. He expresses a desire to explore any treatment options to help him with weight loss. He understands that he is not a suitable candidate for bariatric surgery but has heard that there are some medications that might help.



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Utilization of weight-management medications in clinical practice


Weight-management medications and bariatric surgery can supplement lifestyle interventions to facilitate weight loss (especially a reduction in body fat) and improve health and quality of life.7Many organizations, including the American Society of Bariatric Physicians (ASBP),8The Obesity Society (in collaboration with the American College of Cardiology [ACC] and the American Heart Association [AHA]),9the American Association of Clinical Endocrinologists (AACE),10 and the American College of Endocrinology,10 have published guidelines for the diagnosis and treatment of obesity.

According to prescribing information approved by the Food and Drug Administration (FDA), a BMI of 30 kg/m2or a BMI of 27 kg/m2with obesity-related adverse consequences (type 2 diabetes, hypertension, dyslipidemia) warrants the consideration of a weight-management medication as an adjuvant to lifestyle and behavior modification.

Several medications are approved by the FDA for weight management (Table 1).11However, few clinicians provide weight-management care or prescribe weight-management medications12and fewer than 3 million patients were estimated to use weight-management medications in the United States in 2011.13Reasons for the limited use of pharmacologic agents for weight loss include cost, concerns about safety and efficacy, limited clinician time, and reluctance to view obesity as a disease that warrants treatment.12Compliance with weight-management medications is also low.14

Table 1. Drugs approved by the U.S. FDA for weight management15

Generic name, year of approval Trade name Dosage DEA schedule
Medications approved by the FDA for long-term use
Orlistat, 1999
Orlistat, 2007
Xenical
Alli (over the counter)
120 mg TID
60 mg TID
Not scheduled
Not scheduled
Lorcaserin, 2012 Belviq 10 mg BID IV
Phentermine-topiramate, 2012 Qsymia 3.75 mg/23 mg QD
7.5 mg/46 mg QD
11.25 mg/69 mg QD
15 mg/92 mg QD
IV, due to phentermine component
Naltrexone/bupropion, 2014 Contrave Two 8-mg/90-mg tablets BID Not scheduled
Medications approved by the FDA for short-term use
Phentermine, 1959 Adipex, among others 15 mg–30 mg QD IV
Diethylpropion, 1959 Tenuate
Tenuate Dospan
25 mg TID
75 mg in the am
IV
Benzphetamine, 1960 Didrex 25 mg–50 mg TID III
Phendimetrazine, 1959 Bontril
Prelu-2
17.5 mg–70 mg TID
105 mg QD
III

With the recent addition of 3 new medications and more in development, a growing number of options exist for patients unable to lose weight or maintain weight loss with lifestyle modification alone.