Table 1A.

Summary of anti-obesity medications.

Drug Name	Mechanism of action	Weight loss	Clinical trial data	Side effects	Clinical use
Semaglutide	GLP-1 receptor agonist (GLP1-RA)	Mean change in weight 15% at 17 months	STEP1 trial: 2000 patients randomized to 2.4 mg weekly Semaglutide vs placebo. At 17 months, mean weight loss 15% vs 2.4%.	Transient diarrhea and nausea	Once weekly SC injection approved by FDA 2021.
Liraglutide	GLP1-RA	6.2% at 14 months	SCALE-Maintenance: 500 patients assessed. At 56 weeks Liraglutide patients achieved 6.2% weight loss vs 0.2%.	Hypoglycemia, gastrointestinal and nausea	Daily SC injections approved by FDA 2014.
Tirzepatide	GLP1-RA and insulinotropic polypeptide	Up to 21% at 18 months	SURPASS-2 trial showed superiority to semaglutide. Mean change in A1c 2.3%, and weight 11 kg with the highest dose of 15 mg at 40 weeks.	Gastrointestinal and nausea	SC injections once weekly approved by FDA May/2022 for T2DM. Not approved for obesity management yet but one pharmaceutical company has been granted fast track status by the FDA for its approval.
Orlistat	Gastric and pancreatic lipase inhibitor	Up to 5% at 3 months	Ardissino et al., 37,000 patients to Orlistat vs Placebo. At 6 years, Orlistat group had lower MACE (HR 0,74), lower MI (HR 0.77), lower stroke (HR 0.68), lower HF (HR 0.79), lower CKDIII (HR 0.78), and lower mortalitiy (HR 0.39)	Abdominal discomfort. Fat-soluble vitamin malabsorption	Daily oral medication, approved 1999, and 2002 for over the counter.
Naltrexone-bupropion	Centrally acting (opioid antagonist- dopamine reuptake inhibitor)	5–9 kg at 13 months	COR-1, COR-II, COR-BMOD and COR-DM: 4536 patients to Naltrexone-bupropion vs placebo. At 52 weeks, Naltrexone-bupropion group had 5–9 kg weight loss. Sposito et al.: Naltrexone-bupropion was not associated with the incidence of MACE as compared to placebo. No statistical significance found in the incidence of nonfatal MI or all-cause death.	Nausea, constipation, headache, dizziness, dry mouth	Twice a day oral medication Approved by FDA 2014.
Phentermine-Topiramate ER	Amphetamine analogue- increasing GABA activity and inhibiting glutamate activity	5–10% over 14 months	EQUIP, CONQUER, SEQUEL and 28-week extension study: analysis of the four trials showed that patients with phentermine-topiramate ER had 5–10% weight loss from baseline at of 56 weeks compared to placebo.	Possible increase in heart rate.	Daily oral medication Approved by FDA 2012.