Obesity: Drug treatment only works with lifestyle changes

In the current obesity-promoting environment, obesity prevention requires “a population-based and community-based approach with policies that facilitate access to healthy diets and promote physical activity” and “pharmacological treatments should be limited to obese or overweight people.” a concomitant disease in which weight loss of at least 5% was not achieved through lifestyle changes.

This is one of the conclusions of the latest INFAC pharmacotherapeutic bulletin, prepared by a multidisciplinary committee that included specialists from Osakidetz (primary care pharmacy, family medicine, pediatrics and internal medicine), the Department of Health (and the University of the Basque Country). (EHU-UPV), which, entitled “Medicines for Obesity,” reviews the safety criteria, indications and critical aspects of the use of pharmaceutical drugs for the treatment of obesity.

“To be effective, medications should always be accompanied by lifestyle changes,” the publication states, adding that “the decision to initiate pharmacological treatment for obesity should be made on an individual basis, after careful assessment of the potential benefits and risks of various treatment options (including lifestyle changes, medications or surgical devices).

Pharmacological treatment is indicated only for people with obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 27 kg/m2) and weight-related comorbidities (hypertension, dyslipidemia, cardiovascular disease, obstructive sleep apnea, prediabetes or T2DM) in whom at least 5% weight loss was not achieved with a comprehensive lifestyle intervention over 3-6 months, says the report, which also said it is “important” that the drugs are used in combination with a healthy diet and calorie restriction. , increasing physical activity and behavior modification, as “medications without these changes tend to be ineffective.”

Regarding patient care, the publication recommends that it is important to convey to the public that “individual reactions vary greatly and not all medications are suitable for all people”; that weight loss goals “should be realistic.” In this sense, he believes that weight loss of 5-10% is “a very good response, and weight loss of more than 10% is excellent.”

It is also important to communicate that “weight regain is expected upon completion of pharmacological treatment” and in any case “discontinuation of treatment should be considered if proposed goals are not achieved within a certain time.”

Population approach

Regarding the population-based approach recommended in the publication, it argues that prevention is “crucial” in childhood and adolescence and that fundamental treatment of obesity is based on lifestyle interventions that combine healthy eating with calorie restriction, increased physical activity and behavior. modification.

Likewise, with regard to pharmacological use, they point out that “while drugs such as liraglutide, semaglutide and tirzepatide (the latter not yet approved for the treatment of obesity without diabetes) may represent an advance for people who need to lose weight, they are not a substitute for policy healthcare, greater opportunities are needed to prevent obesity and related diseases.” In this sense, they point out, “there is uncertainty regarding the safety of use of these drugs in the general population and in the long term.”

For all these reasons, obesity prevention requires a social and population-based approach that goes beyond individual responsibility, with public policies that improve access to affordable healthy foods and encourage physical activity.

Among these measures, the ballot includes “taxes on sugary drinks, regulations in the food industry, interventions in school cafeterias, or changes in city planning that promote mobility on foot or by bicycle.”

They are also mindful that WHO is proposing a new health service delivery framework covering obesity prevention and treatment that is universal, accessible, affordable and sustainable, and includes self-care, community interventions, primary and specialist care. obesity services.

In this sense, they emphasize that at the community and primary health care level, “preventive interventions include brief opportunistic interventions to prevent overweight and obesity, self-help advice, support groups, providing opportunities to access physical activity resources, or reinforcing adherence healthy lifestyle, etc.

Finally, the report ensures that “all recommendations share the idea that the approach to overweight and obesity should be multidisciplinary, including health promotion and behavior modification, and in some cases, pharmacotherapy or bariatric surgery.