Prescription Weight Loss Drugs: Patients Want, But Not Long-Term

Highlight from ObesityWeek 2015

Overweight Female with Medication in HandSeveral prescription weight loss drugs have been approved in the U.S since 2012. According to Daniel Bessesen, MD, Professor of Medicine at the University of Colorado, School of Medicine, "Patients want weight loss medications, but not long-term." Dr. Bessesen spoke at ObesityWeek 2015 in Los Angeles about the status of obesity pharmacotherapy. "Patients continue to think of obesity pharmacotherapy as a short-term prospect. I think they are worried about safety."

“Lack of insurance plays into what he sees as underuse of the medications, as do physician inexperience in prescribing, and an atmosphere of skepticism,” he said. Like other experts, he proposes a new paradigm, thinking of prescription weight loss medicines as a treatment for a chronic condition— obesity—similar to how physicians treat hypertension, hyperlipidemia and diabetes.

Brief History of Obesity Pharmacotherapy
Bessesen gave a brief history of prescription obesity medications over the past 18 years.

  • 1997 Dexfenfluramine (Redux) and fenfluramine (Pondimin) removed from the market
  • 1997 Sibutramine (Meridia) approved
  • 1999 Orlistat (Xenical) approved
  • 2004 MetaboLife removed from the market
  • 2006 Rimonabant (Acomplia) approved in Europe
  • 2008 Rimonabant removed from market
  • 2010 Sibutramine removed from market
  • 2012 Phentermine/topiramate (Qsymia) extended-release (ER) approved
  • 2012 Lorcaserin (Belviq) approved
  • 2014 Naltrexone SR/Bupropion SR (Contrave) approved
  • 2014 Liraglutide 3 mg (Saxenda) approved

How Are Prescription Weight Loss Medications Used Now?
Given a choice, what do patients with obesity choose for weight loss? “In one study, nearly one-third chose phentermine/topiramate ER,” said Bessesen, quoting from a trial funded by the Patient Centered Outcomes Research Institute (PCORI).

Weight Loss Meds: The Evidence
“Research suggests strongly that prescription weight loss medicines are effective,” Bessesen said. The American Journal of Preventive Medicine published study outcomes of 4034 adults with obesity; 63% (n=2523) had tried to lose weight in the previous year. The options for weight loss in these 2523 patients were eating less fat, increase exercise, and use of prescription weight loss drugs. Niklas et al concluded that adults with obesity were more likely to experience meaningful weight loss if they ate less fat, exercised more, and utilized prescription weight loss drugs.1

Bessesen commented on studies that reported weight loss dropout rates as high as 46% at the 12-month mark. While not having insurance played a role, physician reluctance—or as Bessesen stated,

"There's an environment of skepticism for these drugs." In a survey of 85 physicians conducted by PCORI, physicians were more comfortable talking with their overweight patients about exercise, lifestyle and portion control. "The past history of adverse outcomes may bias doctors against the class," Bessesen said. “Some doctors may also harbor bias against obesity,” he said. Furthermore, inexperience with prescribing the drugs, as well as lack of time to explain them, may play a role.

New Paradigm Proposed
Like other experts, Bessesen said it's time to treat obesity like other chronic conditions, such as diabetes. "Obesity is not an acute illness, it's a chronic illness," he said. “The traditional thinking, to treat obesity intensely, then back off, clearly does not work,” he said.

Disclosure: Daniel Bessesen, MD serves on the Data Safety Monitoring Board for EnteroMedics®, Inc.

 

November 17, 2015

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