Putting It in Perspective Using Medications for Chronic Weight Management. Donna H. Ryan, MD Pennington Biomedical Research Center

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2 Putting It in Perspective Using Medications for Chronic Weight Management Donna H. Ryan, MD Pennington Biomedical Research Center

3 Why Use Medications? Medications help patients lose more weight when they are trying to diet. Medications can: reduce hunger, improve satisfaction with smaller meals, make patients resist tempting foods or foods they crave or, in the case of Xenical, help reinforce a low fat diet.

4 Why do we need drugs for weight loss? To help patients better adhere to their dietary plan, To help more patients achieve meaningful weight loss, To produce more weight loss so that health benefits will be greater, and To help patients sustain lost weight.

5 Why have medications gotten a bad rap? Older medications were not safe. They weren t studied properly! Short-term studies, few patients. We thought we could produce weight loss and the patient would be cured. The science of obesity was not understood. We thought patients just needed to be told to eat less and exercise more and try harder.

6 How are newer medications evaluated? FDA requires comparison of >2000 patients treated with medication and a similar number on placebo. They evaluate efficacy (average weight loss, percentage who can achieve 5% or more or 10% or more weight loss and improvement in risk factors). They evaluate safety adverse events recorded at every visit, effect on mood recorded at every visit, routing labs and labs of special interest. If the drug passes initial testing a large study (~10,000 people) is conducted testing the effect on heart attack and stroke.

7 When do patients need medications? Medications can help patients who need to lose weight to improve health; who are struggling to lose weight with lifestyle change; who don t have any contraindications to a particular medication; and who need help maintaining lost weight.

8 Some important facts about medications for chronic weight management There is no ideal medication. In the right patient, every medication can be a good medication. In the wrong patient, every medication can be a bad medication. Medications don t work in every patient. The medication profile must be matched to the patient profile. They don t work on their own!

9 Xenical or Alli -otc (orlistat)

10 Belviq (lorcaserin)

11 Qsymia (phentermine/topiramate SR)

12 Contrave (naltrexone SR/bupropion SR)

13 Saxenda (liraglutide 3.0 mg)

14 Thank you!

15 Navigating Medications: Choosing the Options Best for YOU! Christopher D. Still, DO, FACN, FACP

16 General Principles of Choosing Weight Loss Medications ALL medications will be most effective when used in conjunction with a reduced calorie meal plan and increased physical activity The more you can be accountable, (food and exercise logs, daily weights, frequent follow ups*,etc), the greater weight loss. Not every medication will work on every patient Need to have REALISTIC expectations I have lost 35 pounds and hit a plateau I ve developed a tolerance to my medication and it doesn t work anymore

17 Phentermine/Topiramate ER (Qsymia) May help migraine headaches or chronic pain Produced most weight loss of all medications approved Has been used with patients with depression Pregnancy fetal toxicity Glaucoma HYPERthyroidism Uncontrolled blood pressure Heart problems (arrhythmias, etc) Capsules taken daily Produces ~ 12% weight loss after 1 year

18 Lorcaserin (Belviq) Well tolerated; few side effects May help blood sugar control Should not increase blood pressure Caution with depression medications like fluoxetine (Prozac), paroxetine (Paxil), etc Tablet taken twice daily Produces ~7% weight loss after 1 year

19 Naltrexone SR/Bupropion SR (Contrave) Smoker Alcohol use Seizure disorder Uncontrolled blood pressure Opioid use oxycodone Tablets taken twice daily Produces ~ 9% weight loss at 1 year

20 Liraglutide 3.0 mg Diabetic Injected daily Produces ~ 9% weight loss ay 1 year History of pancreatitis Thyroid cancer Kidney probles

21 Odds of Reducing Body Weight by % Categories at 1 Year with Adjunctive Medication Among those who Complete Treatment* % % weight loss 10% weight loss *combined with lifestyle modification

22 Recap Do you have history of glaucoma? Qsymia and Contrave aren t the best choice for you Do you have kidney stones? Avoid Qsymia Do you or a family member have thyroid cancer? Saxsenda is not for you Do you take an SSRI for depression? Qysmia has been used in that patient population Do you need better blood sugar control? Saxsenda and Belviq would be your best option Do you have insurance coverage? NO? Contrave has special pricing

23 Understanding My Surgical Options Walter Medlin, MD, FACS

24 Indications for procedure BMI controversial, but still mostly used >27 with Diabetes, Asian, Indian, Native American >30 with any comorbidity (related problem) DO NOT ASSUME THAT you don t have any until evaluated with exam, labs, sleep study, endoscopy DO NOT ASSUME THAT BMI of 35 is medically required, but still many insurance limits (not Medicaid, few others) Self pay = your & MD call

25 Considerations, Tradeoffs Your tolerance for risk vs uncertainty Money yours or insurance? Diabetes Hiatal Hernia/GERD Weight requirement esp. for knee arthritis Pregnancy plans Mission/overseas work or extended life

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