Medical Management of Obesity

Medical management of obesity is use of pharmacotherapy as an adjunct to reduced calorie diet and increased physical activity to induce weight loss in overweight and obese patients. Drugs for weight loss should be used under careful supervision of medical professional. Drugs cannot replace diet, exercise and lifestyle modification, which remains the cornerstones of obesity treatment. Medical management with use of anti-obesity drugs are indicated for patient with a BMI of ≥30 kg/m², or overweight patients with a BMI of ≥27 kg/m² with at least one weight-related comorbidities such as type 2 diabetes, high cholesterol  and high blood pressure 

Initial steps of weight management is through healthy balanced diet, exercise and behaviour modification. The initial goal of weight loss therapy is reduction of body weight by approximately 10% from baseline within 6 months. Even with 10% of body weight reduction, it has been shown to significantly decrease the severity of obesity and its complications. This is a realistic and achievable target that can be maintained over time. A calorie deficit of 500 to 1000 kcal/day can result in weight loss at a rate of 0.5 to 1 kg/week

Medical management can be consider to help patient maintain compliance with dietary restriction and to achieve weight maintenance after satisfactory weight loss. Overweight or obese patients should be consider for anti-obesity medications if they had a reasonable trial of diet and exercise for 6 months. However, lengthy discussion with patient is needed before initiation for patient to have better understanding of the side-effects profile of the medication prescribed. Anti-obesity drugs can be divided into 2 types, centrally and peripherally acting anti-obesity medications

1. Centrally-acting anti-obesity medication

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

- examples are Liraglutide (Saxenda) 

- it is an approved treatment for type 2 diabetes and was found to have weight loss effect

- GLP-1 receptor agonists works in triggers areas in our brain that control appetite to induce satiety after meal and less hungry resulting in eating less

- among its side-effects are nausea, vomitting, reflux, abdominal pain, diarrhoea, constipation, dizziness, low blood sugar, fatigue, insomnia, dehydration and dry mouth. Serious side effects are pancreatitis (inflammation to organ pancreas), gallbladder disease, thyroid adverse events and kidney problems

- it is given subcutaenously once daily (Saxenda) starting from lowest dose 0.6 mg for 1 week, then increase to 1.2 mg for 1 week, 1.8 mg for one week, 2.4 mg for one week and then maximum dose of 3mg/day (which is the maintenance dose)

- can be used up to 2 years for weight loss management

Phentermine

-  examples are Duromine, Adipex

- initial dose of 15mg and increased up to 37.5mg taken in the morning 

- it is an amphetamine derivative that suppresses appetite

- should only be used short-term (≤3 months) because of their stimulant action on the central nervous system

- side effects are insomnia, dry mouth, constipation, headache, nervousness, restless, tremor, nausea, vomiting, palpitation, irritability, and elevated blood pressure

- it is not recommended for patient with uncontrolled high blood pressure, heart disease or abnormal heart rhythm (arrhythmia) and hyperthyroidsm.  Caution use in patient with anxiety disorders

3. Peripherally- acting anti-obesity medication

Orlistat

- usual dose is 120mg three times a day, can omit if you are not taking high fats or oily foods

- it inhibits pancreatic lipase and prevents fat breakdown in the body into absorbable fatty acid and thereby decreases fat absorption. Unabsorbed cholesterol and fatty acid will then be excreted in faeces

- when 120 mg of Orlistat taken immediately before, during or up to 1 hour after each main meal, ¹/₃ of dietary fat ingested is excreted in stool, reducing fat and calorie intake

- among its side-effects are: flatulence, fatty/oily stools, increased defecation, inability to control bowel movements, loose stools, clay colored stools

- can be used for long-term (up to 4 years) for weight management

If you would like to know more about medical management of obesity, talk to our doctor today for more information