Recommendations Summary

Adult Weight Management (AWM) Medication as Part of a Comprehensive Program

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  AWM: Use of Weight Loss Medications

  FDA-approved weight loss medications may be part of a comprehensive weight management program. Dietitians should collaborate with other members of the health care team regarding the use of FDA-approved weight loss medications for people who meet the NHLBI criteria. Research indicates that pharmacotherapy may enhance weight loss in some overweight and obese adults.

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

    Adverse side effects have been observed in some patients receiving pharmacotherapy for weight management.  Only those drugs apprpoved by the FDA for long term use have data to support long term safety and efficacy.

  • Conditions of Application

    No conditions specified.

  • Potential Costs Associated with Application

    None.

  • Recommendation Narrative

    • Weight loss drugs approved by the FDA may only be used as part of a comprehensive weight loss program, including dietary therapy and physical activity for patients with a BMI of >30 with no concomitant obesity-related risk factors or diseases, and for patients with a BMI of >27 with concomitant obesity-related risk factors or diseases.  Weight loss drugs should never be used without concomitant lifestyle modifications.  Continual assessment of drug therapy for efficacy and safety is necessary.  If the drug is efficacious in helping the patient to lose and/or maintain weight loss and there are no serious adverse effects, it can be continued.  If not, it should be discontinued.  NHLBI Evidence Category B.
    • After successful weight loss, the likelihood of weight loss maintenance is enhanced by a program consisting of dietary therapy, physical activity, and behavior therapy which should be continued indefinitely.  Drug therapy can also be used.  However, drug safety and efficacy beyond 1 year of total treatment have not been established.  NHLBI Evidence Category B.
    • Adverse side effects from the use of weight loss drugs have been observed in patients.  NHLBI Evidence Category A.
    • Using weight loss drugs singly (not in combination) and starting with the lowest effective doses can decrease the likelihood of adverse effects.  NHLBI Evidence Category C.
    • Pharmacotherapy, which has generally been studied along with lifestyle modification including diet and physical activity, using dexfenfluramine, sibutramine, orlistat or phentermine/fenfluramine, results in weight loss in obese adults when used for 6 months to 1 year.  NHLBI Evidence Category B.

  • Recommendation Strength Rationale

    • NHLBI Evidence Categories of A, B and C

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, NIH Publication No. 98-4083, September 1998, produced by the National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases.

    Available at: http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/40.htm

    To access the pdf of the NHLBI Clinical Guidelines click here: http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/index.htm