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Weight loss drugs show ‘modest’ cardiometabolic benefits
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Several weight loss medications approved by the FDA have only modest positive effects on cardiometabolic risk profile, according to new research published in Gastroenterology.
Siddharth Singh, MD, of the division of gastroenterology at the University of California San Diego, and colleagues conducted a systemic review and network meta-analysis of the effects of five FDA-approved weight loss drugs on cardiometabolic risk profile.
“Over one year, these medications had only a modest effect on favorably modifying cardiometabolic risk factors, including glucose profile, lipid profile, blood pressure and waist circumference,” Singh told Healio Gastroenterology and Liver Disease. “The effect size varies between different medications with some being effective for one and others being effective for others.”
Singh and colleagues conducted a meta-analysis of 28 randomized controlled trials that included a total of 29,038 patients with a median BMI of 36.1kg/m2.
The researchers found an association between weight loss medications and a modest decrease in fasting blood glucose and waist circumference, but found no meaningful changes in systolic/diastolic blood pressure or cholesterol profile versus placebo.
“However, it is important to note that even small benefits across multiple cardiometabolic risk factors can have a synergistic effect in lowering cardiovascular morbidity,” Singh said. “Additionally, in a subset of patients who respond well to these medications, favorable effects on cardiometabolic risk profile may be more robust.”
Singh noted that more research is needed to evaluate the impact of weight loss medication on cardiovascular morbidity and mortality. – by Alex Young
Disclosures: Singh reports support from the National Library of Medicine. Please see the full study for a list of all other authors’ disclosures.
Perspective
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Robert H. Eckel, MD
In general, weight-loss drugs have not taken hold in the practice of obesity-related medicine. There are several reasons, including cost of the drugs, experience of health care providers with weight-loss medications, including their efficacy and related adverse effects, and time constraints. Except for generic phentermine, these agents are expensive, and they do not work for every patient. For example, phentermine can control hunger, but will not work for patients who eat for other reasons. These drugs offer only a modest weight reduction of about 4% to 5% beyond placebo in clinical trials. To see cardiometabolic benefits from a weight reduction program, a weight loss of at least 5% to 10% is needed. And, effective weight-loss treatment takes time and good patient education. Physicians must really get to know their patients’ weight history, all their frustrations and all the attempts at weight reduction with or without weight regain. To see health effects of weight loss in the absence of a controlled trial, patients must first restrict calories however they can — on their own, with group support, with weight-loss drugs — to lose about 10% of their body weight. Then they should focus on physical activity to help prevent regain.
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