Obesity and Weight Loss Medications

About this course

In today's healthcare environment, obesity presents a formidable challenge worldwide as its prevalence continues to rise unabated. Among the management strategies available, weight loss medications emerge as pivotal treatment, offering targeted therapeutic options for those unable to lose weight through lifestyle modifications alone. This course aims to provide an overview of pharmacological interventions for weight loss, delving into their mechanisms of action and clinical indications. This course also discusses the various types of Federal Drug Association (FDA) approved and off-label medications, safety profiles, and nursing considerations.

Learning objectives

• Define obesity according to the World Health Organization (WHO), as relates to Body Mass Index (BMI).
• Review the Food and Drug Administration (FDA) approved weight loss medications, their mechanisms of action, and side effects.
• Review off-label use medications that have been prescribed for weight loss.
• Discuss the benefits and contraindications of weight loss medications.
• Review weight loss medication considerations for the pediatric population.
• Understand that weight loss medications should be used as an adjunct to dietary changes and increased physical activity to achieve weight loss goals.

Course outline

20 sections · finish in any order across devices

1. 1

   Introduction

   In today's healthcare environment, obesity presents a formidable challenge worldwide as its prevalence continues to rise unabated. In the US, the economic and social burden of this burgeoning health crisis is staggering, with recent estimations revealing a surge, with costs surpassing $1.4 trillion

   4 min

2. 2

   Describing Obesity

   Obesity is a medical condition where excess body weight poses a risk to health. These conditions are commonly assessed using Body Mass Index (BMI), a measure derived from an individual's weight and height. According to the World Health Organization (WHO), a BMI under 18.5 is underweight, a BMI betwe

   4 min

3. 3

   Epidemiology of Obesity

   Obesity has become a serious health concern in the US and globally, affecting individuals across all age groups and socioeconomic strata. Recent data indicates that approximately 43% of adults, approximately 3 billion people aged 18 and above worldwide, are overweight, and 16% live with obesity.27 I

   4 min

4. 4

   Mechanisms of Action of Weight Management Medications

   Weight management medications employ diverse pharmacological strategies to influence the physiological systems implicated in appetite regulation, metabolism, and energy homeostasis.3 Depending on the class of drugs, these interventions target specific molecular pathways within the central nervous sy

   4 min

5. 5

   Indications for Weight Loss Medications

   Healthcare providers should evaluate several factors, including BMI, co-morbidities, previous weight loss attempts, and psychological state, when prescribing weight loss medication.3 Generally, these medications are recommended to those who are classified as obese or morbidly obese, with a BMI of 30

   4 min

6. 6

   Food and Drug Administration Approved Weight Loss Medications

   In the last 20 years, the Food and Drug Administration (FDA) has approved six weight-loss drugs for long-term use. These include8:

   4 min

7. 7

   Bupropion-Naltrexone(Contrave)

   Bupropion-naltrexone is a combination drug that was approved by the FDA in 2014.8 Naltrexone, an opioid receptor antagonist, is typically used in the treatment of alcohol and opioid addiction. Bupropion is known for its dual role as an antidepressant and an aid to stop smoking. Studies have shown th

   4 min

8. 8

   Liraglutide (Saxenda)

   Liraglutide is a subcutaneous GLP-1 agonist used for managing both type 2 diabetes mellitus and weight in diabetic individuals with obesity.8 It was approved by the FDA in 2014 after studies demonstrated participants achieving upwards of 5% weight loss compared to those on placebo.6 In overweight or

   4 min

9. 9

   Orlistat (Xenical, Alli)

   Federal drug administration approved in 1999, orlistat is an oral pancreatic lipase and gastric lipase inhibitor that can limit fat absorption by as much as 30%.8 Research demonstrates that in combination with diet and exercise, orlistat can reduce BMI, body weight, waist circumference, and levels o

   4 min

10. 10

    Phentermine-Topiramate (Qsymia)

    Phentermine-topiramate is a combination medication consisting of phentermine, a sympathomimetic, and topiramate, an anticonvulsant.8 Phentermine functions by suppressing appetite by increasing norepinephrine activity in the CNS. Topiramate decreases appetite and enhances satiety by acting as a gamma

    4 min

11. 11

    Semaglutide (Wegovy)

    Semaglutide is a long-acting GLP-1 receptor agonist for the management of type 2 diabetes and, in 2021, was approved by the FDA for weight loss.6 In clinical trials, including the Semaglutide Treatment Effect for People with Obesity (STEP) program, it was administered subcutaneously and showed parti

    4 min

12. 12

    Setmelanotide (Imcivree)

    Setmelanotide is a melanocortin-4 receptor (MC4R) agonist that binds to and activates MC4 receptors in the hypothalamus, specifically those involved in appetite regulation.23 This mechanism of action leads to appetite suppression and increased resting energy expenditure in humans with obesity. Unlik

    4 min

13. 13

    Off-label Weight Loss Medications

    Certain medications, which are FDA-approved for other conditions, are prescribed off-label for weight management because weight loss has been seen as a secondary effect of their primary action based on emerging evidence, clinical experience, or medical judgment.7 They are not approved by the FDA bec

    4 min

14. 14

    Benefits

    Weight loss medications have been shown to facilitate significant and sustained reductions in body weight when used as part of a comprehensive weight management program.1 Depending on the dosage, individuals can achieve clinically meaningful weight loss, typically defined as losing 5% - 7% of their

    4 min

15. 15

    Contraindications

    Weight loss medications can be effective tools for managing weight, but they come with potential risks and contraindications that must be carefully considered.3 One significant concern is the long-term impact weight loss medications can have on cardiovascular health. Individuals with a history of he

    4 min

16. 16

    Safety of Weight Loss Medication Use in Children

    When considering the safety of weight loss medication use in children, age is a critical factor. Pediatric obesity management guidelines emphasize a cautious approach, typically reserving pharmacological interventions for adolescents who have severe obesity, noteworthy co-morbidities, and have faile

    4 min

17. 17

    Importance of Physical Activity and Healthy Diet

    Weight loss medications are not standalone treatments. Rather, they are adjunctive therapies to be used within a comprehensive weight management plan that includes dietary counseling and physical activity recommendations.1 Patients should receive individualized dietary counseling from registered die

    4 min

18. 18

    Discontinuation of Weight Loss Medications

    Weight loss medications may be discontinued for various reasons but must also be carefully managed to ensure patient safety and optimal health outcomes.1 If a patient successfully achieves their weight loss goals and maintains a healthy weight, discontinuing the medication may be considered. However

    4 min

19. 19

    Nursing Considerations

    The administration and management of weight loss medications necessitate a nuanced approach that integrates clinical expertise with patient-centered care principles.22 Nurses play a pivotal role in the continuum of care, from initial assessment to ongoing monitoring and patient education. As frontli

    4 min

20. 20

    Conclusion

    Weight management medications represent a crucial component in the multifaceted approach to combat the escalating global crisis of overweight and obesity. They can help individuals achieve clinically meaningful weight loss, improve metabolic parameters, enhance physical functioning, and boost psycho

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Atlas, Steven J, et al. Medications for Obesity Management: Effectiveness and Value. Vol. 29, no. 5, 1 May 2023, pp. 569–575, https://doi.org/10.18553/jmcp.2023.29.5.569.
• Bello, Nicholas, and NC Liang. “The Use of Serotonergic Drugs to Treat Obesity – Is There Any Hope?” Drug Design, Development and Therapy, Feb. 2011, p. 95, dx.doi.org/10.2147%2FDDDT.S11859, https://doi.org/10.2147/dddt.s11859.
• Chakhtoura, Marlene, et al. “Pharmacotherapy of Obesity: An Update on the Available Medications and Drugs under Investigation.” Pharmacotherapy of Obesity: An Update on the Available Medications and Drugs under Investigation, vol. 58, 1 Apr. 2023, pp. 101882–101882, https://doi.org/10.1016/j.eclinm.2023.101882.
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• FDA. “FDA Approves New Drug Treatment for Chronic Weight Management, First since 2014.” FDA, 4 June 2021, www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014.
• Hendricks, Ed. “Off-Label Drugs for Weight Management.” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, vol. Volume 10, June 2017, pp. 223–234, https://doi.org/10.2147/dmso.s95299.
• Idrees, Zarwa, et al. “FDA-Approved Pharmacotherapy for Weight Loss over the Last Decade.” Cureus, vol. 14, no. 9, 17 Sept. 2022, https://doi.org/10.7759/cureus.29262.
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• Nagi, Karim, and Abdella M. Habib. “Biased Signaling: A Viable Strategy to Drug Ghrelin Receptors for the Treatment of Obesity.” Cellular Signalling, vol. 83, July 2021, p. 109976, https://doi.org/10.1016/j.cellsig.2021.109976. Accessed 6 May 2021.
• NIH. “Overweight & Obesity Statistics .” National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, 13 Dec. 2018, www.niddk.nih.gov/health-information/health-statistics/overweight-obesity.
• Petersen, Ruth, et al. “Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.” Preventing Chronic Disease, vol. 16, no. 16, 11 Apr. 2019, www.cdc.gov/pcd/issues/2019/18_0579.htm, https://doi.org/10.5888/pcd16.180579.
• Pray, Rachel, and Suzanne Riskin. “The History and Faults of the Body Mass Index and Where to Look Next: A Literature Review.” Cureus, vol. 15, no. 11, 3 Nov. 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC10693914/, https://doi.org/10.7759/cureus.48230.
• Rangbulla, AdityaKumar. “Obesity Treatment – Is Pharmacotherapy the Answer?” International Journal of Applied and Basic Medical Research, vol. 10, no. 3, 2020, p. 147, https://doi.org/10.4103/ijabmr.ijabmr_113_20. Accessed 3 July 2022.
• Research, Center for Drug Evaluation and. “FDA Approves Treatment for Chronic Weight Management in Pediatric Patients Aged 12 Years and Older.” FDA, 27 June 2022, www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-chronic-weight-management-pediatric-patients-aged-12-years-and-older.
• ---. “FDA Approves Weight Management Drug for Patients Aged 12 and Older.” FDA, 30 Sept. 2021, www.fda.gov/drugs/news-events-human-drugs/fda-approves-weight-management-drug-patients-aged-12-and-older.
• ---. “FDA Requests the Withdrawal of the Weight-Loss Drug Belviq, Belviq XR (Lorcaserin) from the Market.” FDA, 13 Feb. 2020, www.fda.gov/drugs/drug-safety-and-availability/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market.
• Singhal, Vibha, et al. “Pharmacotherapy in Pediatric Obesity: Current Evidence and Landscape.” Current Opinion in Endocrinology, Diabetes & Obesity, vol. 28, no. 1, 12 Nov. 2020, pp. 55–63, https://doi.org/10.1097/med.0000000000000587.
• Tchang, Beverly G., et al. “Long‐Term Weight Loss Maintenance with Obesity Pharmacotherapy: A Retrospective Cohort Study.” Obesity Science & Practice, 2 Dec. 2021, https://doi.org/10.1002/osp4.575.
• Trapp, Christine M, and Marisa Censani. “Setmelanotide: A Promising Advancement for Pediatric Patients with Rare Forms of Genetic Obesity.” Current Opinion in Endocrinology, Diabetes and Obesity, vol. 30, no. 2, 2 Feb. 2023, pp. 136–140, https://doi.org/10.1097/med.0000000000000798.
• Turer, Christy Boling. “Tools for Successful Weight Management in Primary Care.” The American Journal of the Medical Sciences, vol. 350, no. 6, 1 Dec. 2015, pp. 485–497, www.ncbi.nlm.nih.gov/pmc/articles/PMC4666822/, https://doi.org/10.1097/MAJ.0000000000000530.
• Wang, Jing-Yue, et al. “GLP−1 Receptor Agonists for the Treatment of Obesity: Role as a Promising Approach.” Frontiers in Endocrinology, vol. 14, 1 Feb. 2023, p. 1085799, www.ncbi.nlm.nih.gov/pmc/articles/PMC9945324/#B23, https://doi.org/10.3389/fendo.2023.1085799.
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• World Health Organisation. “Obesity and Overweight.” World Health Organization, 1 Mar. 2024, www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
• Zhu, Da Q, et al. “Nurses’ Self-Efficacy and Practices Relating to Weight Management of Adult Patients: A Path Analysis.” International Journal of Behavioral Nutrition and Physical Activity, vol. 10, no. 1, 2013, p. 131, https://doi.org/10.1186/1479-5868-10-131.

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