Pharmacotherapy

Case 3. AP is a 62-year-old patient who comes to your office for advice about losing weight. He has a history of obesity, a current body mass index (BMI) of 38 kg/m², and obstructive sleep apnea. Approximately 6 months ago, he and his wife started going to the gym and have been adhering to the Mediterranean diet. Despite these efforts, he has only been able to lose approximately 2.3 kg.

Pharmacotherapy should be offered as initial treatment of overweight and obesity for adults with weight-related comorbidities and for those at high risk for complications, and as a component of first-line management for patients with obesity and overweight without comorbidities.¹ In the clinical trials conducted to obtain US Food and Drug Administration (FDA) approval for anti-obesity drugs, specific reduced calorie diets (eg, 500 kcal/day deficit, 1,200 kcal/day diet), physical activity (eg, 150 minutes per week), and diet counseling were also prescribed.^2,3 All drugs are approved as adjuncts to diet and lifestyle changes and should be considered as a component of comprehensive care for obesity. Drug selection should be based on effectiveness, comorbidities (eg, hypertension, diabetes, heart failure), cost, and patient preferences (Table 1^1,2 and Table 2^1,4–7). Drugs known to promote weight gain should be modified or discontinued if possible (refer to Section One, Table 3).