New National Guidelines for Obesity Medications

Red and yellow capsule amongst plain white ones
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Following the release of four new anti-obesity medications in just the past two years, an expert task force has, for the first time, released new national guidelines for physicians and other health care practitioners who may wish to prescribe these new drugs. The new guidelines, which were published online in January 2015 and in print in February 2015, are intended to provide guidance for clinicians when anti-obesity medications may be appropriate for treatment.

Obesity as a Disease

The guideline recommendations emphasize that obesity is, indeed, a disease, and should be treated as such. In 2013, the American Medical Association (AMA)  officially declared obesity to be a disease, acknowledging the “enormous humanitarian and economic impact of obesity as requiring the medical care, research and education attention of other major global medical diseases.”

Building on the recognition of obesity as a disease, as well as on previous obesity guidelines released in 2013 by the American Heart Association, American College of Cardiology, and The Obesity Society, this current set of guidelines offers advice for the medical treatment of obesity to include prescription medications.

Importantly, these new guidelines also provide recommendations to clinicians on how they can avoid using medications that are known to cause or contribute to overweight and obesity.

Benchmark for Effectiveness

The guidelines note that the accepted benchmark for deciding whether or not a particular anti-obesity medication is effective is that magical 5%. A weight-loss medication is considered to be effective if it results in a 5% weight loss after 3 months. If it does this, it should be continued.

However, if the medication fails to reach this benchmark, then it should be discontinued and another one should be tried, or a surgical approach should be considered, according to the guidelines.

Diet and Exercise Still Important

The guidelines are careful to point out that diet, exercise, lifestyle changes and behavior modification remain an important part of any obesity-management program.

Most national and international guidelines recommend getting at least 150 minutes of moderate-intensity exercise every week. What counts as moderate-intensity exercise? Physical activities such as general gardening, brisk walking, ballroom dancing, and the equivalent fall into the category of moderate-intensity exercise.

Additionally, according to the Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services (HHS), obtaining at least 1 hour and 15 minutes of vigorous-intensity exercise weekly can meet the minimum amount of recommended exercise. Vigorous-intensity exercise includes physical activities such as hiking uphill, bicycling at or above ten miles per hour, fast swimming, running, traditional aerobics, and heavy shoveling or ditch digging, among others.

Sources:

Apovian CM, Aronne LJ, Bessessen DH, McDonnell ME, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2015;100:342-62.

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. Circulation.

Physical Activity Guidelines for Americans. United States Department of Health and Human Services. Accessed online at http://www.health.gov/PAGuidelines/ on March 23, 2015.

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