brand logo

Am Fam Physician. 2022;106(1):online

Clinical Question

Are any medications effective for weight loss and improving health in adults who are obese or overweight?

Bottom Line

Several medications are more effective than lifestyle modification in achieving short-term weight loss at the expense of adverse events. Although quality of life scores are improved, it is unclear if weight loss with medication results in fewer adverse health events. (Level of Evidence = 1a−)

Synopsis

The authors searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov to identify randomized trials of various medications that promote weight loss in adults who are overweight or obese. The included trials did not have to include people with comorbid conditions but had to compare a medication with lifestyle modification with or without a placebo. The studies had to report weight loss–related data and quality of life scores but did not have to report other health outcomes (e.g., gastrointestinal symptoms, body image, changes in blood pressure, changes in laboratory parameters such as glycated hemoglobin, lipid levels). The authors also accepted data that were not necessarily analyzed by intention to treat. They included 143 unique trials with 49,810 participants, 75% of whom were women. The median length of the trials was 24 weeks. The authors identified a high risk of bias due to protocol deviations and missing outcome data, and they had concerns about how adverse events were assessed. They decided to perform a network meta-analysis. They found that phentermine/topiramate (Qsymia) was the most effective medication for achieving at least a 5% weight loss (odds ratio [OR] = 8.02; 95% CI, 5.24 to 12.27), followed by glucagon-like peptide-1 (GLP-1) receptor agonists (OR = 6.33; 95% CI, 5 to 8). The order of effectiveness in achieving at least a 10% weight loss was the same. Although effective in achieving weight loss, most drugs had significant discontinuation rates due to adverse events: naltrexone/bupropion (Contrave; OR = 2.69; 95% CI, 2.11 to 3.43), phentermine/topiramate (OR = 2.40; 95% CI, 1.69 to 3.42), GLP-1 receptor agonists (OR = 2.17; 95% CI, 1.71 to 2.77), and orlistat (Xenical; OR = 1.72; 95% CI, 1.44 to 2.05). Quality of life scores improved to a greater degree for phentermine/topiramate (standardized mean difference [SMD] = 0.42), followed by naltrexone/bupropion (SMD = 0.36), and GLP-1 receptor agonists (SMD = 0.29). The authors reported that compared with lifestyle modification, medications caused greater degrees of lower glycated hemoglobin and lipid levels but not systolic blood pressure. For most of the data, the authors report significant heterogeneity. They do not report on other important outcomes, such as mortality, cardiac events, development or regression of diabetes, and so forth.

AgentNumber needed to treat to achieve at least 5% weight lossNumber needed to treat to achieve at least 10% weight lossNumber needed to harm for discontinuation
Phentermine/topiramate (Qsymia)3317
Glucagon-like peptide-1 receptor agonists3320
Naltrexone/bupropion (Contrave)3414
Pramlintide (Symlin)No significant differenceNo significant differenceNo significant difference
Sodium-glucose cotransporter-2 inhibitors (SGLT-2)5No significant differenceNo significant difference
Orlistat (Xenical)5931
Metformin6No significant differenceNo significant difference

Study design: Meta-analysis (randomized controlled trials)

Funding source: Foundation

Setting: Various (meta-analysis)

Reference: Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet. 2022;399(10321):259-269.

Already a member/subscriber?  Log In

Subscribe

From $145
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available

Article Only

$25.95
  • Immediate, unlimited access to just this article
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading

More in AFP

More in Pubmed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.