Adding a weight-management medication

Patients should be counseled on realistic weight-loss expectations when initiating treatment with a weight-management medication and on the importance of medication adherence for achieving optimal weight loss. Generally, patients regard 15% weight loss as the minimum acceptable weight loss at 1 year.40

Patients should be counseled that clinically significant improvements that reduce cardiovascular and metabolic risk and improve quality of life can be achieved with 5% to 10% weight loss.1,8,41-43Additional weight loss may be possible with lifestyle modification. Furthermore, in patients with type 2 diabetes, weight loss (achieved with lifestyle modification and/or weight-management medication) can reduce the number of glucose-lowering medications needed to achieve HbA1C goals.

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Continuation of case study

John is an excellent candidate for a weight-management medication because his BMI is greater than 27 and he has diabetes, hypertension, and dyslipidemia. In addition to weight loss, weight-management medications are associated with metabolic benefits, including improved blood glucose andHbA1C, blood pressure, and lipids. Because the patient already has increased cardiovascular risk, weight-management medications that can increase blood pressure and/or pulse should be used with caution. In addition, blood pressure and pulse should be monitored regularly (Table 2).

Depending on the type of medication, weight loss of 3% or greater can be expected. For all weight-management medications, John should be evaluated regularly to monitor for adverse events and changes in weight and cardiovascular risk factors. Because not everyone responds to treatment with weight-management medications by achieving clinically significant weight loss, weight-loss response should be monitored and the medication dose or type adjusted accordingly (Table 2).15