Incorporating evidence-based approaches to reducing obesity—including screening, counseling, medication, and surgery, when appropriate—may be effective in managing obesity.
This clinician's aid highlights research from the evidence-based practice program of the Agency for Healthcare Research and Quality (AHRQ). This research informs many science-based recommendations in the public and private sector, including the U.S. Preventive Services Task Force (USPSTF).
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Obesity is a risk factor for heart disease, type II diabetes, hypertension and stroke, hyperlipidemia, osteoarthritis, sleep apnea, and cancer. Even modest weight loss can reduce the risk of these diseases.
Medication, Dosage | Weight Loss1 By Time | Side Effects | Relative Risk Compared with Placebo |
---|---|---|---|
Bupropion 400 mg/day |
1-5 kg, 6-12 mo | Dry mouth Diarrhea Constipation Upper respiratory problems |
2.3 1.3 1.3 1.1 |
Diethylpropion 75 mg/day |
2-12 kg, 6-12 mo | NR | NR |
Fluoxetine 60 mg/day |
3-7 kg, 6 mo 1-6 kg, 12 mo |
Nervousness/sweating/tremors Nausea/vomiting/fatigue/asthenia Hypersomnia/somnolence Insomnia Diarrhea |
6.4 2.7 2.4 2.0 1.7 |
Orlistat (Dosage NR) |
2-3 kg, 6 mo 2-3 kg, 12 mo |
Diarrhea Flatulence Bloating/abdominal pain/dyspepsia |
3.4 3.1 1.5 |
Phentermine 15-30 mg/day |
1-6 kg, 6 mo | NR, but can expect: Palpitations Tachycardia Elevated blood pressure Central nervous system effects Gastrointestinal effects Case reports of stroke have been reported but causality cannot be assumed. |
NR |
Sibutramine 10 or 20 mg/day |
4-6 kg, 4-6 mo 4-5 kg, 12 mo |
Modest increases in heart rate and blood pressure | NR |
Topiramate 96-192 mg/day |
5-8 kg, 6 mo | Taste perversion Paraesthesia Constipation Dry mouth Central nervous system effects Upper abdominal symptoms Fatigue Upper respiratory problems Diarrhea |
9.2 4.9 3.5 2.9 2.0 1.6 1.3 1.2 1.0 |
Zonisamide 100-600 mg/day |
6% of baseline body weight, 4 mo | Fatigue | NR |
1 Weight loss estimates based on a 95% confidence interval. |
This clinician's aid is based on the following work supported by the Agency for Healthcare Research and Quality (AHRQ):
Shekelle PG, Morton SC, Maglione M, et al. Pharmacological and Surgical Treatment of Obesity. Evidence Report/Technology Assessment No. 103. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
U.S. Preventive Services Task Force. Screening for obesity in adults: recommendation statement. Ann Intern Med 2003;139(11):930-2.
For more information on AHRQ's Evidence-based Practice Centers, contact Beth Collins Sharp, Ph.D., R.N., at BCSharp@ahrq.gov.
Current as of October 2004
AHRQ Publication No. 04-0082
Internet Citation:
Managing Obesity: A Clinician's Aid. AHRQ Publication No. 04-0082, October 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/obesaid.htm
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