Fast Five Quiz: Confronting Obesity

Romesh Khardori, MD, PhD; Elif A. Oral, MD


January 31, 2022

In order to promote long-term weight maintenance, guidelines from the Endocrine Society recommend the use of an approved weight loss medication over not using pharmacologic therapy in patients with a BMI of ≥ 30 or a BMI of ≥ 27 and at least one associated comorbid medical condition (eg, hypertension, type 2 diabetes, dyslipidemia). In patients with cardiovascular disease who seek pharmacologic treatment for weight loss, orlistat is recommended. In addition, the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide (2.4-mg/week subcutaneous dose) was approved by the US Food and Drug Administration in June 2021 for patients with an initial BMI of ≥ 30 and for those with a BMI of ≥ 27 in the presence of at least one weight-related comorbid condition. The approval was based on four phase-3 clinical trials involving approximately 4500 patients with overweight or obesity that showed a 15%-18% weight loss over 68 weeks.

The guidelines also recommend against the use of the sympathomimetic agents phentermine and diethylpropion in patients who have obesity with a history of cardiovascular disease or uncontrolled hypertension.

For patients who present with obesity the guidelines recommend using antidiabetic medications that have additional actions to promote weight loss (eg, GLP-1 analogs, sodium-glucose cotransporter 2 [SGLT] inhibitors) in addition to metformin.

Learn more about the pharmacologic treatment of obesity.


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