Editorial: A timely topic

Abstract

This issue of Obesity Consults has a single focus – using medications in weight management. It's a timely topic, since prior to 2012 only orlistat (Xenical) was available and now there are 4 newer medications available for prescription. Certainly orlistat has a place in our treatment toolbox, but it doesn't affect appetite and reward eating, which are major challenges to our patients who struggle with weight loss. Two new medications were approved in 2012 – lorcaserin (Belviq®) and phentermine/topiramate ER (Qsymia™). Then, in 2014 naltrexone SR/bupropion SR (Contrave®) was marketed and liraglutide 3.0 mg (Saxenda®) was approved by the FDA. We expect liraglutide 3.0 mg to be marketed in 2015. Interestingly, after a tampering scare, orlistat was taken off the market and is expected to be reintroduced in 2015. There are other medications in the pipeline, but it will be several years before we see additions to our therapeutic armamentarium, so this issue of Obesity Consults is “a keeper”. It provides up-to-date information for providers who use weight management as a pathway to health management and it is likely to only need updating after several years have passed. We begin with basics. The principles of prescribing for chronic weight loss are discussed in our first piece (authored by myself). It is the background information that all prescribers need to know, before they begin the work of deciding which medication to use. We follow this with two papers that deal with issues that largely determine the choice of medications. Certainly efficacy is important and we lead off with a discussion written by Dr. Rekha Kumar and Dr. Louis Aronne that largely focuses on the efficacy of currently available medications. This paper describes the amount of weight loss one could expect on average with a medication and also what the odds might be for achieving meaningful weight loss. We know that no one medication works in every patient – that is why we need multiple options. In addition, not every medication has an appropriate safety and tolerability profile for every patient. We are fortunate to have Dr. Ken Fujioka, a clinician with broad patient experience with all of these medications discuss the safety and tolerability profiles of currently available medications. Of course every provider knows that the most important thing is to put didactic information to use to benefit patients. We provide this context with a case report co-authored by Dr. Lotfi, Kenya Palmer, ARNP, and Dr. Apovian. They describe a patient with type 2 diabetes, a commonly encountered problem. Most of our diabetic patients are obese, many of our medications for diabetes management also have effect on weight and weight management is central to good diabetes management. This case provides an excellent illustration of how to succeed at weight loss in diabetic patients. While weight loss in type 2 diabetes can be a challenge, it is important that all providers engage in their patients' weight loss efforts, because the benefits in type 2 diabetes are profound. Obesity Consults ends with an interview with Dan Bessesen, MD. Dan is an endocrinologist who participated in the development of Clinical Guidelines sponsored by the Endocrine Society. These Guidelines will fill an important gap – authoritative recommendations from a respected professional society on the emerging evidence of medicating for weight management and avoiding medications that promote weight gain. Medicating for weight management is a timely topic, indeed. We are ushering in a new era of weight management, with more tools to help patients who struggle. Read and enjoy!