At the ENDO 2015 meeting this week, I had the great pleasure of sitting in on a session about medications to treat obesity, a presentation provided by Dr Caroline Apovian. Dr Apovian is the lead author of the Endocrine Society’s Clinical Practice Guideline for the Pharmacological Management of Obesity (published in January 2015).
It’s an exciting time in the US for treating obesity, as the FDA has now approved a total of 6 medications for the treatment of obesity. The six medications available are (ordered as they appear in the guidelines):
- phentermine
- topiramate + phentermine
- lorcaserin
- orlistat
- naltrexone + bupropion
- liraglutide (approved, not yet available on shelves)
Most other countries in the world do not have access to so many options to treat obesity with medications – for my Canadian readers, we have only two (orlistat, and liraglutide, which has just been approved by Health Canada but is not yet on shelves).
In her discussion of these medications, Dr Apovian made some poignant points about the use of medications to treat obesity – specifically, that we are far behind in approving and accepting the use of medications to treat obesity, compared to other chronic medical conditions like diabetes or high blood pressure, where we have many different medications to choose from. While the reasons for this are complex, it stems at least in part from the stigma that still surrounds obesity – the reluctance by both health care professionals and the general public to accept obesity as a chronic disease and not just a symptom or a lifestyle ‘problem’.
These medications are intended for use in addition to lifestyle changes, in people who have had unsuccessful attempts at lifestyle changes to lose weight. Dr Apovian pointed out another contrast in our approach to obesity with other chronic health issues: specifically, that it is interesting that we do not categorically require a patient with high blood pressure to ‘fail’ a low salt diet before starting medication, and we do not require a patient with high cholesterol to ‘fail’ a low fat diet before recommending cholesterol lowering medication.
These new Clinical Practice Guidelines (where you can read the details about these medications) is the first of its kind – it recommends that we look at obesity as the central problem to address and treat, rather than focussing only on the complications of obesity, as we have traditionally tended to do.
I couldn’t agree more. We are in need of a Revolution in our thinking – namely, to consider the obesity as the central fulcrum of clinical attention and treatment. In other words, we need to treat the obesity itself, while simultaneously addressing the complications of obesity that are present. By targeting treatment towards the obesity, we often see an improvement in many of the complications associated with obesity, thereby improving the overall health of our patient.
