obesity diagnosis. Patients with a BMI of 20.0-24.9 are considered “healthy weight patients”,
while patients with a BMI of 25-29.9 fall into the category of overweight. Patients with a BMI
over 35 are considered obese, and above that number, obesity is classified into three classes
stratified by severity. Treatment of obesity starts with lifestyle changes and behavioral
modification. These treatments are the foundation of all obesity treatment and should be used in
combination with other therapies. If a patient’s BMI is greater than 30, or greater than 27 and
accompanied by complications or comorbidities, pharmaceutical treatment is suggested. When a
patient’s BMI exceeds 39.9, weight loss surgery is considered. This is generally a step that only
occurs after other methods have tried and failed. Regardless of weight loss treatment, education,
lifestyle changes, and behavioral therapy are key to continued weight loss and wellness (Garvey
et. al., 2016)
A2a: Pharmacological treatments.
There are five different prescription drugs that are currently approved by the F.D.A. for
long-term treatment of obesity. These medications include orlistat (Xenical), phentermine and
topiramate (Qsymia), lorcaserin (Belviq), bupropion and naltrexone (Contrave), and liraglutide
3.0 (Saxenda). Orlistat is a pancreatic lipase inhibitor, acting to promote weight loss by blocking
absorption of 30% of fat when following a low-fat diet. The exact action of the combination of
OBESITY
6
phentermine and topiramate is unknown, but the two medications work together to suppress
appetite and enhance satiety. Lorcaserin is a serotonin 2c receptor agonist that helps control
appetite by activating serotonin receptors and promoting the feeling of satiety. Bupropion is a
dopamine and noradrenaline reuptake inhibitor, so in combination with naltrexone’s opioid
receptor antagonist action, the drug has been shown to promote moderate weight loss. As a GLP-
1 agonist, liraglutide helps the pancreas regulate insulin release to achieve appetite control. Each
of these drugs can be used long-term, which creates a stable and sustainable weight loss pattern
for individuals struggling with obesity (Bray et. al., 2016).
There are four medications that are currently approved for short-term use (<12 weeks),
but the most commonly used is phentermine. These short-term medications suppress appetite and
increase resting energy expenditure by acting on the sympathetic nervous system to increase the
release of norepinephrine (Bray et. al., 2016). Insurance coverage of these medications differs
from state-to state, so use is varied in each community. In the state of Kansas, there is no
mandate on coverage of treatments for obesity, so the use of pharmaceutical treatment is greatly
varied by the patient’s ability to pay for different treatments (The National Institute of Diabetes
and Digestive and Kidney Diseases [NIDDK], 2018).
