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JAMA Patient Page
June 2, 2015

Medications for Weight Loss: Indications and Usage

JAMA. 2015;313(21):2196. doi:10.1001/jama.2015.5575

Medications can help with weight loss in certain groups of people, but there is no “magic” pill.

Medications for weight loss work best when combined with a lifestyle treatment program, and such medications require close monitoring by a doctor.

Who Should Take Medications for Weight Loss

Lifestyle approaches to help people who are overweight or obese follow a healthy reduced-calorie diet and increase their physical activity are always the first and most important steps in treating obesity. Unfortunately, for many people it is difficult to lose weight and even harder to maintain weight loss. More than 1 of 3 Americans today are obese, which is defined as having a body mass index (BMI) of 30 or higher.

Medications are sometimes used to help with weight loss in people who are obese and who have not been able to lose weight or maintain weight loss with diet, exercise, or behavioral treatment. Sometimes, weight loss medications are prescribed for people with a BMI of between 27 and 30 if they have other health problems such as diabetes, high cholesterol, heart disease, high blood pressure, or obstructive sleep apnea. Using the medications along with lifestyle treatment improves weight loss outcomes.

How Weight Loss Medications Should Be Used

There are several medications approved by the US Food and Drug Administration for long-term treatment (more than 3 months). These medications all have side effects, so they need to be closely monitored by a doctor. In general, if a patient does not lose at least 5% of his or her starting weight after taking a full dose of the medication for 3 months, that medication should be stopped, and the doctor should decide what other types of treatment may be helpful. The medications approved for long-term treatment may lead to improvements in some risk factors for heart disease or diabetes, but some of the medications increase pulse or blood pressure and should be used with caution in patients with a history of heart disease. No obesity medication has been shown to lower risk of developing heart disease or stroke. Obesity medications should not be used by women who are pregnant or planning to become pregnant.

Managing Expectations

It is important to have realistic expectations when starting a weight loss medication. The amount of weight loss is less than what many people expect—about 5% to 10% of the starting weight on average. However, people vary in their response, with some people losing less weight and others losing much more. Like other medications taken for chronic conditions such as high blood pressure, obesity medications do not work after they are stopped, so gradual weight regain is likely after discontinuing the drug. Ask your doctor if you have questions about whether a weight loss medication may be right for you.

In a second Patient Page on medications for weight loss, specific medications will be discussed.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Sources: Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86.

Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014;312(17):1779-1791.

Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-362.

Topic: Endocrinology and Metabolism