Intended for healthcare professionals

Clinical Review State of the Art Review

Effectiveness and safety of drugs for obesity

BMJ 2024; 384 doi: (Published 25 March 2024) Cite this as: BMJ 2024;384:e072686
  1. Kristina Henderson Lewis, assistant professor1 2,
  2. Caroline E Sloan, assistant professor, core faculty2 3 4,
  3. Daniel H Bessesen, professor5,
  4. David Arterburn, manager and senior investigator, affiliate professor6 7
  1. 1Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
  2. 2Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
  3. 3Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
  4. 4Margolis Center for Health Policy, Duke University, Durham, NC, USA
  5. 5Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
  6. 6Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
  7. 7Division of General Internal Medicine, University of Washington, Seattle, WA, USA
  1. Correspondence:
    K H Lewis, khlewis{at}


Recent publicity around the use of new antiobesity medications (AOMs) has focused the attention of patients and healthcare providers on the role of pharmacotherapy in the treatment of obesity. Newer drug treatments have shown greater efficacy and safety compared with older drug treatments, yet access to these drug treatments is limited by providers’ discomfort in prescribing, bias, and stigma around obesity, as well as by the lack of insurance coverage. Now more than ever, healthcare providers must be able to discuss the risks and benefits of the full range of antiobesity medications available to patients, and to incorporate both guideline based advice and emerging real world clinical evidence into daily clinical practice. The tremendous variability in response to antiobesity medications means that clinicians need to use a flexible approach that takes advantage of specific features of the antiobesity medication selected to provide the best option for individual patients. Future research is needed on how best to use available drug treatments in real world practice settings, the potential role of combination therapies, and the cost effectiveness of antiobesity medications. Several new drug treatments are being evaluated in ongoing clinical trials, suggesting that the future for pharmacotherapy of obesity is bright.


  • State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors.

  • Contributorship: All authors participated in the literature review, interpretation of literature, drafting of the manuscript, and revision of the manuscript. DA is the guarantor.

  • Competing interests: KHL reported receiving personal fees from National Committee for Quality Assurance for serving as a faculty member on a continuing medical education activity about obesity outside the submitted work.

  • DA reported receiving reimbursement from the American Society for Metabolic and Bariatric Surgery for travel expenses to the 2023 annual meeting.

  • DHB has received research funding and compensation for consulting work from Eli Lilly and Novo Nordisk.

  • CES has no conflicts of interest to declare.

  • Provenance and peer review: commissioned; externally peer reviewed.

View Full Text