Dr Eric Pugliesi
Weight Management Medication
A persistent public misperception is that lifestyle modification alone (ie, eat less and exercise more) is the most effective therapy for any level of obesity.
On the contrary, lifestyle modification alone is the least effective in terms of the magnitude of weight loss and the duration of maintaining the lower weight for patients who struggle with obesity.
Similarly, in the short-term, treatments such as very low-calorie diets may induce large loss and improvements in health status, but long-term maintenance of the lower weight is improbable. When patients desire to lose at least 10% of their body weight, lifestyle change alone is likely to be ineffective in part because of metabolic adaptation to weight loss.
Even after years of unsuccessful attempts at dieting, patients continue to believe that they simply need to try harder to eat less and make more time to exercise. They have little understanding of the concepts of set point for fat mass (ie, the genetically determined range of body weight and body fat) and how fat loss increases metabolic efficiency, priming the body to regain weight.
When patients feel desperate to lose weight, they often attempt extreme diets and exercise programs, but these efforts are usually temporary. Unfortunately, patients may then abandon their efforts to lose weight altogether after experiencing an endless cycle of losing and regaining weight, which culminates in the perception of personal failure.
It is difficult to demystify the concepts described and medication is usually seen as the last resource when it should be considered as a strong ally.
Your healthcare team may recommend medications as part of your obesity management plan, alongside behavioural changes. Before starting a new medication, your healthcare professional will discuss and consider a number of different factors such as your health history, BMI, other complications of obesity, such as type 2 diabetes or high blood pressure and possible side effects.
In Australia, 4 prescription medications are available for the treatment of overweight and obesity.
The following chart has been adapted from the Obesity Hub Website.