Pharmacotherapy in Obesity Management

  • There are three medications indicated for chronic obesity management in Canada in addition to health behaviour changes: liraglutide (Saxenda®) 3.0 mg, naltrexone/bu­propion (Contrave®) in a combination tablet, and orlistat (Xenical®). All three medications have been shown to be effective in producing weight loss greater than placebo for a duration of at least one year.
  • Medications that are not approved as pharmacotherapy for obesity management should not be used for this purpose.
  • The individual response to obesity management pharma­cotherapy is heterogeneous; the response to medications can differ from patient to patient. In choosing the most ap­propriate obesity pharmacotherapy, consider mechanism of action, safety, potential side effects/tolerability, contraindica­tions, drug interactions, mode of administration and cost.
  1. Pharmacotherapy for weight loss can be used for individuals with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with adiposity-related complications, in conjunction with medical nutrition therapy, physical activity and psychological interventions (liraglutide 3.0 mg [Level 2a, Grade B)], naltrexone/bupropion combi­nation [Level 2a, Grade B],4 orlistat [Level 2a, Grade B]).
  2. Pharmacotherapy may be used to maintain weight loss that has been achieved by health behaviour changes, and to prevent weight regain (liraglutide 3.0 mg or orlistat) (Level 2a, Grade B).
  3. For people living with type 2 diabetes and a BMI ≥ 27 kg/m2, pharmacotherapy can be used in conjunction with health behaviour changes for weight loss and improvement in glycemic control: liraglutide 3.0 mg (Level 1a, Grade A); naltrexone/bupropion combination (Level 2a; Grade B),8 orlistat (Level 2a, Grade B).
  4. We recommend pharmacotherapy in conjunction with health behaviour changes for people living with prediabetes and overweight or obesity (BMI > 27kg/m2) to delay or pre­vent type 2 diabetes. (Liraglutide 3.0 mg (Level 2a, Grade B); orlistat (Level 2a, Grade B).
  5. We do not suggest the use of prescription or over-the-counter (OTC) medications other than those approved for weight management (Level 4, Grade D, Consensus).
  6. For people living with overweight or obesity who require pharmacotherapy for other health conditions, we suggest choosing drugs that are not associated with weight gain (Level 4, Grade D, Consensus).
  • Obesity medication can help you in your obesity manage­ment journey when health behaviour changes alone have not been effective or sustainable.
  • There are three medications approved for long-term obesity management in Canada: liraglutide 3.0 mg (Saxenda®), naltrexone/bupropion in a combination tablet (Contrave®) and orlistat (Xenical®). These medications can help you to achieve and maintain a 5%–10% weight loss and improve health complications associated with excess weight. These medications are approved by Health Canada and have been proven in robust clinical trials to be effective for obesity management.
  • Medications that are not approved for obesity treatment may not be safe or effective for obesity management and should be avoided.

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