HQ Team
October 25, 2022: For the first time, the American Gastroenterology Association (AGA) has released new evidence-based guidelines recommending the long-term use of four approved anti-obesity medications for adult patients who haven’t been able to lose weight through lifestyle changes alone. The new recommendations will be published in the November 2022 issue of Gastroenterology.
“There have been changes in obesity treatment in recent years. This guideline is the first since diabetes drugs were approved for obesity treatment and provide clear information for doctors and their adult patients who struggle to lose weight or keep it off with lifestyle changes alone,” said a co-author of the findings, Perica Davitkov, MD, a professor in the department of medicine at Case Western Reserve University in Cleveland, Ohio, in a press release.
Body mass index or BMI is used to calculate your weight category of whether you are normal, heavy or obese. A person with BMI of 25 to 29.9 is considered overweight, and a person with a BMI of over 30 is considered to be obese. More than ⅔ of all Americans. More than 1 billion people worldwide are obese – 650 million adults, 340 million adolescents and 39 million children. This number is still increasing. WHO estimates that by 2025, approximately 167 million people – adults and children – will become less healthy because they are overweight or obese.
And obesity fuels a cascade of negative health impacts — from increased risk of type 2 diabetes, heart disease, and cancer, to just about every major chronic health ailment.
Weight loss medications should be used along with healthy eating and regular physical activity, according to the guidelines. Four medications have been approved and shown to result in moderate weight loss as a percentage of body weight (reported as the difference compared with a percentage of weight loss observed in the placebo group).
- Semaglutide (Wegovy) weight loss percentage: 10.8 percent
- Phentermine-topiramate ER (Qsymia) weight loss percentage: 8.5 percent
- Liraglutide (Saxenda) weight loss percentage: 4.8 percent
- Naltrexone-bupropion ER (Contrave) weight loss percentage: 3.0 percent
“These medications treat a biological disease, not a lifestyle problem,” said another author, Eduardo Grunvald, MD, of the University of California in San Diego. “Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term. Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver, and hypertension.”
The American Medical Association (AMA) designated obesity a disease in 2013. Experts say genetics, environment, social determinants of health, and biological factors influenced by medications, illnesses, and hormones all play a role in obesity.
Dieting and exercise are the recommended route to lose weight. A 2020 report from the CDC found that about 17 percent of Americans report being on a diet — that’s up from 14 percent in the previous decade. But to keep that weight off is a big problem. Nealry 8 out of 10 people who go on a diet regain their weight in a year or so.
In a meta-analysis of 29 long-term weight loss studies, more than half the lost weight was regained within two years, and by five years more than 80 percent of the lost weight was regained.
Obesity Epidemic
More widespread use of these medications could absolutely slow the obesity epidemic, says Fatima Cody Stanford, MD, MPH, an associate professor of medicine and pediatrics at Harvard Medical School in Boston and an obesity specialist at Massachusetts General Hospital, who was not involved in writing the new recommendations.
Dr. Fatima Cody Stanford, an obesity specialist at Massachusetts General Hospital, wrote a paper published in December 2021 in the Mayo Clinic Proceedings that found only 1 percent of Americans who meet the criteria for weight loss medication actually receive it.
“It is important to note that this is not the case with any other chronic disease,” says Stanford. This is due in part to the misperception that obesity is a lifestyle choice rather than a disease, she says.
She believes that making the medicines available to people who are obese may be able to stem the obesity epidemic that is currently in the US and slowly becoming a worldwide phenomenon.
Weight loss medication eligibility
People may be prescribed a weight loss drug if they haven’t been able to lose weight through diet and exercise and meet one of the following:
- Have a BMI greater than 30
- Have a BMI greater than 27 and an obesity-related chronic disease such as type 2 diabetes, heart disease, or obstructive sleep apnea
“It is important to note that these medications are used chronically, which means that they will not be stopped. Many people think that they will go on the medications and come off once they reach a particular weight, but stopping the medications (if they have been effective) will only lead to weight regain,” she says.
