page_title: Management of obesity
section_title: Medication
hierarchical_section_title: Management of obesity / Medication
caption_attribution_description: English: Medication used for obesity. Orlistat and sibutramine.
context_page_description: Management of obesity can include lifestyle changes, medications, or surgery. The main treatment for obesity consists of weight loss via dieting and physical exercise. Diet programs can produce weight loss over the short term and long-term, although combining with exercise and counseling provide greater results. Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child. The National Institutes of Health recommend a weight loss goal of 5% to 10% of the person's current weight over six months.
  One medication, orlistat, is current widely available and approved for long term use. Weight loss is modest to important, with an average of 2.9 kg at 1 to 4 years, but there is little information on how these drugs affect longer-term complications of obesity. Its use is associated with high rates of gastrointestinal side effects.
  The most effective treatment for obesity is bariatric surgery. Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
context_section_description: Several anti-obesity medications are currently approved by the FDA for long term use.  Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase.
  Lorcaserin has been found to be effective in the treatment of obesity with a weight loss of 5.8 kg at one year as opposed to 2.2 kg with placebo and it is approved by the Food and Drug Administration for use in the treatment of obesity. Side effects may include serotonin syndrome.
  The combination drug phentermine/topiramate (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic weight management.
  Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.  European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits. Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.
  Weight loss with these drugs is modest. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb), sibutramine is 4.2 kg (9.3 lb) and rimonabant is 4.7 kg (10 lb). Orlistat and rimonabant lead to a reduced incidence of diabetes, and all three drugs have some effect on cholesterol. However, there is little information on how these drugs affect the longer-term complications or outcomes of obesity.  In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.
  There are a number of less commonly used medications. Some are only approved for short term use, others are used off-label, and still others are used illegally. Most are appetite suppressants that act on one or more neurotransmitters.  Racemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short term use, while bupropion, topiramate, and zonisamide are sometimes used off-label.  Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.
  The usefulness of certain drugs depends upon the comorbidities present.  Metformin is preferred in overweight diabetics, as it may lead to mild weight loss in comparison to sulfonylureas or insulin. The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity.  Diabetics also achieve modest weight loss with fluoxetine, orlistat and sibutramine over 12–57 weeks. Preliminary evidence has however found higher number of cardiovascular events in people taking sibutramine verses control (11.4% vs. 10.0%). The long-term health benefits of these treatments remain unclear.
  Fenfluramine and dexfenfluramine were withdrawn from the market in 1997, while ephedrine (found in the traditional Chinese herbal medicine má huáng made from the Ephedra sinica) was removed from the market in 2004.
  Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this. There is also no strong evidence to recommend herbal medicines for weight loss.
caption: Orlistat (Xenical) the most commonly used medication to treat obesity and sibutramine (Meridia) a withdrawn medication due to cardiovascular side effects
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