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Practice Therapeutics

Pharmacotherapy for weight loss

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3526 (Published 06 June 2014) Cite this as: BMJ 2014;348:g3526

Re: Pharmacotherapy for weight loss

Many obese people suffer from co-morbid conditions, the treatment of which can itself impact on body weight. In the exemplar patient with type 2 diabetes,1 it would be worthwhile reviewing concurrent therapies that may contribute to weight gain, such as sulphonylureas and insulin. Instead, a combination of metformin and glucagon-like peptide-1 receptor agonist or sodium glucose co-transporter-2 (weight loss) or dipeptidyl peptidase-4 inhibitor (weight-neutral) may be more favourable.2-4 Similarly, in the obese patient with painful diabetic neuropathy duloxetine (weight-neutral) may be preferable to amitriptyline, gabapentin or pregabalin (weight gain). Whilst tricyclic and tetracyclic antidepressants and mood stabilisers such as lithium and valproate induce carbohydrate-craving and weight gain, the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors (weight-neutral) and topiramate (weight loss) have a better pharmacological profile for the obese patient with depression.5

Thus, a rational choice of drug therapy tailored to the obese person’s clinical co-morbidity would be of greater value than the mere addition of (sometimes ineffectual) weight loss medications.

References
1. Rueda-Clausen CF, Padwal RS. Pharmacotherapy for weight loss. BMJ 2014;348:g3526.
2. Vilsboll T, Christensen M, Junker AE, Knop FK, Gluud LL. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ 2012;344:d7771.
3. Clar C, Gill JA, Court R, Waugh N. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open 2012;2(5):e001007.
4. Karagiannis T, Paschos P, Paletas K, Matthews DR, Tsapas A. Dipeptidyl peptidase-4 inhibitors for treatment of type 2 diabetes mellitus in the clinical setting: systematic review and meta-analysis. BMJ 2012;344:e1369.
5. Rosko T. Psychiatric medications and weight gain: a review. Bariatric Times 2011;8(3):12-15.

Competing interests: No competing interests

17 June 2014
Akheel A Syed
Consultant Endocrinologist & Honorary Senior Lecturer
Salford Royal NHS Foundation Trust & University Teaching Hospital
Stott Lane, Salford M6 8HD