Outpatient Medical Weight Loss
Liana Mosley
Background
- 74% of US adults are overweight/obese.
- Target weight loss of 5-7% body weight for prevention of co-morbidities.
- In general, encourage lifestyle modifications (dietary interventions, exercise) first.
- See Obesity/Nutrition under Outpt Medicine.
Management
- Consider referral to medical weight loss: BMI ≥ 30 or ≥ 27 with with ≥ 1 co-morbidity.
- Referral to surgical weight loss: BMI ≥ 35 or ≥ 30 with ≥ 1 co-morbidity.
Medical Weight Loss
Medication | Mechanism | Side Effects | Other Considerations |
|---|---|---|---|
| Metformin | Unclear MOA, potentially appetite suppression | N/V/D, lactic acidosis in renal failure | Low cost, T2DM prevention/treatment |
| Orlistat (Xenical) | Reduces fat absorption | Fatty diarrhea, gas, abdominal pain | Significant side effect profile |
| Phentermine-topiramate (Qsymia) | Appetite suppression, early satiety | Constipation, dizziness, dry mouth, taste changes, anxiety, insomnia, HTN, tachycardia, cognitive slowing, nephrolithiasis | Risk of rebound weight gain Discontinuing can lead to withdrawal |
| Phentermine (Ionamin) | Reduces appetite, FDA-approved for short-term use (up to 12 wks) | Constipation, dizziness, dry mouth, taste changes, anxiety, insomnia, HTN, tachycardia | Risk of rebound weight gain Discontinuing can lead to withdrawal |
| Naltrexone- bupropion (Contrave) | Appetite suppression, early satiety | Constipation, diarrhea, dizziness, dry mouth, HA, increased BP, tachycardia, insomnia, liver damage, N/V, SI | Risk of rebound weight gain Discontinuing can lead to withdrawal Cannot use if pt is on opioid therapy Consider alternative if h/o seizures |
| Liraglutide (Saxenda) | GLP-1 agonist >Appetite suppression/p> Victoza: low dose formulation, FDA approved for T2D but not weight loss | N/V/D, constipation, abdominal pain, HA, tachycardia, dizziness, injection site reaction, pancreatitis | Contraindicated: pancreatitis, medullary thyroid ca, MEN2A - MEN2B |
| Semaglutide (SQ or PO Wegovy/Rybelsus) | >GLP-1 agonist >Appetite suppression/p> Rybelsus = PO option, FDA approved for T2D but not weight loss | N/V/D, abdominal pain, constipation, injection site reaction, pancreatitis | STEP8 RCT: Semaglutide >Liraglutide Contraindicated: pancreatitis, medullary thyroid ca, MEN2A/MEN2B |
| Tirzepatide (Zepbound) | GLP-1 agonist + GIP receptor agonist | N/V/D, abdominal pain, constipation, injection site reaction, pancreatitis | T2DM: superior to GLP1 agonist (lowered A1c 2.0-2.5%) Obesity: weight loss of 15-20% from bl CContraindicated: pancreatitis, medullary thyroid ca, MEN2A/MEN2B |