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Am Fam Physician. 2023;108(4):424-426

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Semaglutide is the most effective medication for weight loss and produces a total weight loss of 10% or more with a number needed to treat of 2 compared with lifestyle interventions alone.

• Phentermine/topiramate extended-release produces a total weight loss of 10% or more with a number needed to treat of 3 compared with lifestyle interventions alone.

• Phentermine monotherapy produces a total weight loss of 10% or more with a number needed to treat of 6 compared with lifestyle interventions alone. 

From the AFP Editors

Nearly 42% of Americans, up from 30% in 2000, are obese. The limited effectiveness of lifestyle changes alone increases the need for effective, long-term treatment for those with a body mass index (BMI) greater than 30 kg per m2 or BMI of 27 kg per m2 or greater with associated complications (e.g., hypertension, diabetes mellitus, and hyperlipidemia). The American Gastroenterological Association performed a systematic review to publish guidelines for managing obesity with medications.

Most Effective Medications

The American Gastroenterological Association established 3% weight loss as the minimally important difference for determining effectiveness of medication over lifestyle interventions alone. For a person who weighs 90.7 kg (200 lb), this would be an excess weight loss of 2.7 kg (6 lb). Four medications meet that criterion.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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