Fast Five Quiz: Management of Obesity

Elif A. Oral, MD; Evelyn S. Marienberg, MD


December 19, 2022

Sodium-glucose co-transporter 2 inhibitors (eg, dapagliflozin, canagliflozin, and empagliflozin) are used to treat type 2 diabetes, but they also lead to body weight loss, largely accounted for by body fat reduction. These agents directly cause body weight loss via glucose excretion (calorie loss) in the kidneys.

The US FDA requires an antiobesity drug to improve cardiometabolic parameters, including glycemic control, blood pressure, and lipid levels. Glucagon-like peptide 1 agonists (eg, exenatide, liraglutide, and semaglutide) have been shown to lead to body weight loss and improve glycemic control in patients with obesity or overweight. In all SCALE trials, liraglutide resulted in a greater improvement vs placebo in glycemic control, blood pressure, lipid levels, and health-related quality of life in participants with obesity or overweight. Semaglutide has also shown efficacy in improving cardiometabolic risk factors and achieving significant weight loss in individuals with obesity or overweight when administered subcutaneously once weekly.

In the SCALE Sleep Apnea trial, liraglutide significantly lowered the apnea/hypopnea index in patients without diabetes and with obesity who had moderate or severe obstructive sleep apnea vs placebo. Greater reductions in glycated hemoglobin and systolic blood pressure were also seen with liraglutide vs placebo.

Stimulants (eg, phentermine) may be used as second-line agents in the management of obesity. Phentermine combined with topiramate is sometimes used for weight loss, but its safety and efficacy related to cardiovascular disease is still under investigation.

Learn more about pharmacotherapy for the management of obesity.

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