Benefits of Weight Loss Medications on Obesity Co-Morbidities

Obesity is associated with significant morbidity and premature mortality and is increasing at alarming rates across the globe. Furthermore, less than a quarter of the qualifying adults and children get the needed treatment. Lifestyle modification therapy is the most commonly used treatment for obesity, yet it has limited efficacy and durability in most cases. Weight loss medications are an effective adjunct in inducing weight loss, particularly in patients in whom surgical intervention is not desired, recommended or successful. A handful of medications are FDA-approved in the US for long term use in adults with obesity and only one is approved for children under 16 years of age.

For both adults and children, weight loss medications have beneficial effects from the induced weight reduction and some medications may have additional benefits, sometimes independent of weight loss. For example, Contrave (bupropion and naltrexone) may also help with depression. Similarly, the beneficial effects of the glucagon like peptide-1 (GLP-1) analogues on glucose metabolism are well known. However, there are insufficient data to support the use of these medications for many other obesity related co-morbidities like infertility, hypogonadism, musculoskeletal symptoms, sleep apnea, liver disease, and mood disorders among others. It would be helpful to gather data regarding the use of these medications for a broad range of obesity co-morbidities and if one is preferred over another in a clinical scenario.

Furthermore, there are no rigorous long-term data in the younger population about the safety profile of weight loss medications. There is a tremendous barrier at both the parent, patient and provider level regarding the safety and the need to use weight loss medications even in severe obesity. More peer reviewed literature highlighting outcomes of the use of these medications in children and adolescents will help educate the caregivers and mitigate the barriers that lead to suboptimal care of children and adolescents with obesity.

In addition to the expanded benefits of some weight loss medications, there may be side effects from these medications that have not been studied. For example, there are limited data on the cardiovascular effects of phentermine or the cognition and memory effects of topiramate when these medications are used for prolonged periods of time. It is essential to be skeptical and seek information when using medications for a chronic disease without needlessly denying appropriate treatment for patients.

The goal of this Research Topic is to bring forth the lesser known benefits, concerns or side effects of weight loss medications. It should highlight the utility of these medications in improving not only obesity status but also weight-related co-morbidities. It also aims to generate curiosity and raise questions to improve outcomes in patients - both young and old with obesity. These enquiries, in form of Original, Review, and Commentary articles - by highlighting the gaps in current knowledge; may form the basis of future research.