Antiobesity Medication Overview
Antiobesity Medication Overview
MaineHealth Let’s Go! Shorts Video Series
Screeners, Labs, and Testing for a Patient with Obesity | Episode 7
Resources
FDA Approved Anti-Obesity Medications | https://www.ncbi.nlm.nih.gov/books/NB…
How Much Weight Loss Is Needed to Improve Health? | https://mmc.instructure.com/courses/5…
From Case in Point: Addressing Practical Questions to Improve Long-Term Outcomes in Patients With Obesity by Juan Pablo Frias, MD | https://lrn.peerview.com/150208512_1/…
0:00 - Welcome
0:30 - Assess - Medications
1:17 - Weight Loss Medications
2:16 - The Good News!
2:44 - Small Steps
3:05 - How Much Weight Loss Is Need to Improve Health?
3:16 - FDA Approved Medications
4:27 - Current FDA Approved Antiobesity Medications
Content
10.769 -> Welcome back to another edition of Let’s
Go!
12.49 -> Shorts where we are teaching you how to be
more comfortable and competent to care for
16.68 -> your patients with obesity.
18.17 -> I am Dr. Peter Amann, a medical bariatrician
in Portland, Maine.
22.51 -> We are going to do an overview of medications
this time, and in the next Shorts we’ll
26.33 -> give more specific information on each of
these medications.
30.609 -> In the previous Let’s Go!
31.609 -> Shorts we discussed evaluation and testing
for patients that are dealing with the disease
35.46 -> of obesity.
36.649 -> Part of the workup includes a review of current
and prior medications patients have used which
41.39 -> may have contributed to weight gain.
43.16 -> There is a long list of medications that can
affect appetite and weight including some
47.93 -> antidepressants, diabetic medications such
as insulin and glipizide, steroids, certain
53.129 -> blood pressure medications, and antipsychotics.
56.52 -> Some patients being treated with certain antipsychotics
can gain significant weight up to 10-20 pounds
61.859 -> even in a few months.
63.399 -> Also, generally medications that are sedating
such as antihistamines or sleep medications
68.02 -> can increase appetite.
69.48 -> When possible, if weight is a concern, we
should think about using alternative medications
73.939 -> that are weight neutral or can promote weight
loss.
78.4 -> Weight loss medications can be considered
in the interested patient with a BMI above
82.13 -> 27 and comorbid disease such as hypertension,
diabetes, fatty liver disease, or sleep apnea,
89.07 -> or in a person with a BMI above 30.
91.97 -> Traditionally a medication could be FDA approved
for weight loss if it showed at least a 5%
96.05 -> decrease in weight over a 3 month period.
99.45 -> A 10 or 15% weight loss is considered excellent.
103.06 -> Historically there have been weight loss medications
like Phen Phen, Meridia, or Lorcaserin which
108.56 -> have come and gone – taken off the market
due to significant or potential side effects
113.31 -> so some providers are nervous about starting
these medications, which can be very expensive
117.38 -> and have significant side effects.
119.659 -> Also both the prescriber and the patient need
to understand weight gain often recurs when
124.21 -> these medications are stopped and patients
still need to work on lifestyle changes to
128.099 -> increase their chance of success.
130.47 -> This underlies the reality that obesity, like
other chronic diseases, needs to be treated
134.879 -> often long-term.
135.879 -> The good news is, even a 3 to 5% weight loss
can promote meaningful improvement in health,
144 -> lower triglycerides and blood sugars, and
decrease the risk for developing diabetes.
148.01 -> 5 to 10% or more weight loss can reduce blood
pressure, improve LDL and HDL, and decrease
154.04 -> the need for medications for diabetes or hypertension.
157.53 -> More than a 10% weight loss can improve sleep
apnea, fatty liver disease, and reduce heart
162.489 -> attacks, and improve mortality.
164.19 -> I often use the analogy of a gallon of milk
which weighs 8 pounds.
167.849 -> If a patient is 250 pounds and a 5% weight
loss occurs, this is 12 to 13 pounds.
175.12 -> A 10% weight loss is 25 pounds, or the same
as taking a backpack off which contains 3
180.819 -> gallons of milk!
181.93 -> That weight loss is significant and noticeable
to the patient.
185.78 -> Here is a graphic about the goal for impactful
weight loss and the greater benefits seen
191.06 -> with greater weight loss.
192.879 -> You can download this graphic in the description
of this video or in Canvas.
198.44 -> Cost of weight loss medications can be an
issue for many patients.
202.409 -> Many insurance companies including Medicare
and Medicaid do not cover antiobesity medications
206.57 -> at all, which may reflect the stigma and bias
against patients with obesity.
211.29 -> The Treat and Reduce Obesity Act was first
introduced to Congress in 2012 and reintroduced
215.819 -> in 2021 to include coverage of FDA approved
antiobesity medications, which can improve
221.019 -> qualify of life and be life-saving.
223.28 -> Some of the older medications can be created
off-label as generic medications which often
227.939 -> are cheaper.
228.959 -> The newer GLP-1 injectables can be very effective
for weight loss but often are not covered
233.189 -> without a diagnosis of diabetes and can be
over $1,000 per month.
237.47 -> None of these medications are safe with pregnancy.
240.959 -> For dosing, start at a low dose and titrate
slowly.
244.379 -> Close follow-up is important to assess for
side effects, and the goal is at least a 5%
248.93 -> weight loss at 12 weeks.
250.769 -> If not, consider a higher dose if possible,
changing, or adding a medication.
255.489 -> Let’s quickly go through the available medications
just as an overview.
259.459 -> This will not make you an expert at this time,
but hopefully will provide you familiarity
263.729 -> for you with these medications to learn more
about them.
268.25 -> There are currently 9 FDA approved medications
for the treatment of obesity.
271.97 -> These include stimulants such as Phentermine
and Diethylpropropion which were FDA approved
276.44 -> decades ago and only initially tested for
short-term use.
280.65 -> The rest of the medications are approved for
longer term use which addresses obesity as
284.75 -> the chronic disease it is.
287.02 -> For the next Let’s Go!
288.07 -> Shorts we will spend some time on each of
them, so you might eventually become comfortable
292.63 -> trying them with some of your patients once
you are familiar with their use and side effects.
Source: https://www.youtube.com/watch?v=pGliaLqaNGY