Obesity is a chronic, relapsing disease and should be managed as such. Along with lifestyle intervention, pharmacotherapy (medications) can be a useful tool in effecting and maintaining clinically meaningful weight loss. Pharmacotherapy should be considered in those with BMI >30kg/m2 or those with BMI >27-30 kg/m2 with obesity related complications. Pharmacotherapy can be used in both patients that have never had weight loss surgery, as well as those that have. In those that have had weight loss surgery, the use of medications may be useful in cases of insufficient weight loss, as well as those that have experienced weight regain.
The use of medications for weight loss
In Australia the Therapeutic Goods Administration (TGA) has approved the use of several different medications for weight loss – terzepatide, semaglutide, liraglutide, phentermine, orlistat, and bupropion/naltrexone. There are also other medications that have been proven to be successful weight loss medications, that are not TGA approved for weight loss in Australia. They are therefore sometimes prescribed “off label” for weight loss.
The use of medications for weight loss is not a ‘one size fits all’ process. Treatment is individualised to the patient and results will vary from person to person. The average weight loss achieved in patients taking weight loss medications is 5-15% of total body weight. For some people it is less than this, for some it is more (20% or greater).
While generally well tolerated, weight loss medications do have some limitations- cost, potential side effects, contraindications (such as pregnancy), and the possibility of weight regain when the medications are stopped. Evidence shows that the long -term use of weight medications is safe in the majority of patients. Therefore some patients may stay on therapy long term, while others use it for a shorter duration to aid weight loss while building good long term lifestyle habits.
