Medical group urges medication, not just diet and exercise, to treat obesity

Oct. 20 (UPI) -- New guidelines released Thursday urge doctors to pair certain medications with lifestyle changes for overweight and obese adult patients to increase their chance of successful weight loss over the long term.

The American Gastroenterological Association, which issued the recommendations, underscored that obesity is a biological disease, not a lifestyle problem, that affects more than 4 in 10 U.S. adults, up from 30.5% over the past two decades.

The Centers for Disease Control and Prevention says obesity is "a common, serious and costly disease."

The clinical practice guidelines, published in the journal Gastroenterology, recommend medications that, when paired with healthy eating and regular physical activity, are first-line medical options to be used as initial, or primary treatment, and can result in moderate weight loss.

The four drugs suggested in the guidelines as safe and effective for long-term weight management are Wegovy, or semaglutide, with a 10.8% weight-loss percentage; Qsymia, or phentermine-topiramate ER, 8.5%; Saxenda, or liraglutide, 4.8%; and Contrave, or naltrexone-bupropion ER, 3.0%.

The guideline panel recommended against using a medication called orlistat, sold as Xenical.

"These medications treat a biological disease, not a lifestyle problem. Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term," Dr. Eduardo Grunvald, the guidelines' primary author and professor of medicine at the University of California-San Diego, said in a news release.

Grunvald, an internist and board-certified obesity medicine physician at UC San Diego Health, said using medications as an option to help lose weight can improve weight-related complications such as joint pain, diabetes, fatty liver and hypertension.

In June 2021, the Food and Drug Administration approved the Wegovy injection for chronic weight management in adults who are obese or overweight and have at least one weight-related condition, for use alongside a reduced calorie diet and increased physical activity.

It was the first obesity management drug approved since 2014.

Dr. Beverly Tchang, an endocrinologist and obesity medicine specialist at Weill Cornell Medicine's Comprehensive Weight Control Center in New York City, told UPI in an email that the new guideline is "excellent."

"It's comprehensive without overextending. I like that they very clearly highlight the basic principles of prescribing obesity pharmacotherapy -- for example, chronic disease requires chronic treatment, individualized regimens -- and they provided an excellent synthesis of the data available from [clinical trials]," said Tchang, an assistant professor of clinical medicine.

However, Tchang said she wishes the guideline authors had incorporated more commentary on the cost and accessibility of these medications "since most people still do not have insurance coverage for them, though [the authors] do acknowledge that this may further widen the health disparity gap."

Dr. Catherine Welford Varney, a UVA Health family medicine physician in Charlottesville, Va., who specializes in obesity medicine and is board-certified in both fields, said she also sees the new guidelines in a positive light.

"This is fantastic news. This confirms that a majority of physicians, even those that work outside obesity medicine, understand that 'eat less, exercise more' mono-therapy for obesity is an antiquated plan to recommend to patients," Varney, UVA's bariatric surgery obesity medicine director, told UPI in an email.

She added, "We now understand the physiology of obesity and [that it] is a complicated chronic disease due to multiple underlying issues including genetics, epigenetics, hormonal, environmental and socioeconomic factors."