Help Your Patients Manage Obesity

About 1 in 4 Canadians struggle with obesity...but you can help them manage it as New Year’s resolutions kick in.

Continue to emphasize lifestyle changes...and review med lists for possible causes of weight gain (antipsychotics, steroids, etc).

Updated Canadian guidelines recommend considering meds for patients with a BMI of 30 or more...or 27 or more plus an obesity-related condition (diabetes, hypertension, etc).

When available, lean toward new Rx Wegovy (semaglutide) 2.4 mg subcutaneously weekly. Using it for about a year leads to about 13% more weight loss than placebo...or 13 kg for a 100 kg patient.

This is at least double the weight loss of Saxenda (liraglutide) 3 mg subcut daily per year...or around triple that of oral Contrave (naltrexone/bupropion) 16/180 mg bid or Xenical (orlistat) 120 mg tid.

But Wegovy shortages are an issue. Don’t recommend using Ozempic (semaglutide) off-label unless your patient also has diabetes...since an Ozempic shortage is also a concern.

Point out that GI side effects are common with Saxenda or Wegovy...but most patients can tolerate either with slow titration.

And both come with a rare risk of gallbladder problems and pancreatitis.

If patients prefer an oral med, lean toward Contrave. It may benefit patients who are also trying to quit smoking...or those with depression. But avoid it in patients with seizures.

Xenical may cause loose, oily stools and vitamin deficiencies.

Point out differences in cost. Saxenda is about $420/month...Contrave $300/month...and Xenical $150/month. Expect Wegovy to compete in cost with Saxenda.

Consider switching to another med if patients don’t lose at least 5% of their body weight after 3 months on a therapeutic dose.

But if patients are seeing results, explain that long-term use may be needed...to help maintain weight loss.

Steer patients away from OTCs or supplements promoting weight loss...these don’t have much evidence of benefit.

Learn more about the different meds in our resource, Weight Loss Products.

Key References

  • https://obesitycanada.ca/guidelines/ (12-21-22)
  • CMAJ. 2020 Aug 4;192(31):E875-E891
  • Gastroenterology. 2022 Nov;163(5):1198-1225
Pharmacist's Letter Canada. January 2023, No. 390117



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