Pharmacotherapy

Anti-obesity drugs should be offered as initial treatment of overweight and obesity for adults with weight-related comorbidities and for those at high risk of complications, and as a component of first-line treatment for patients with obesity and overweight without comorbidities. Currently, US Food and Drug Administration–approved drugs for obesity include centrally acting drugs, gastrointestinal lipase inhibitors, and incretin mimetics. Other drugs are used off-label to promote weight loss. The incretin mimetics, glucagon-like peptide-1 receptor agonists (eg, semaglutide, liraglutide) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist (ie, tirzepatide), demonstrate the greatest weight loss benefits, with tirzepatide achieving reductions exceeding 20% in some patients. Drug selection should be individualized based on comorbidities (eg, cardiovascular disease, obstructive sleep apnea), cost, and patient preference. Despite growing evidence of benefit, barriers (eg, prescriber hesitancy, high costs, limited insurance coverage) persist. With multiple drugs in development, continued innovation in pharmacotherapy management offers promise, but expanding education and access remains critical to improving obesity care.