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Four of the newer agents (lorcaserin, liraglutide 3.0 mg, naltrexone SR/ bupropion SR, and phentermine/topiramate ER) all act primarily in the central nervous system. They regulate appetite and reduce food intake to help patients better adhere to a dietary plan.

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Orlistat acts peripherally to block absorption of 30% of ingested fat and reinforces adherence to a low-fat diet, thus reducing energy intake. These five newer medications are intended for long-term use to help patients not only lose more weight than with lifestyle changes alone

but also to maintain hard-won weight losses. Best practices in chronic disease prevention and management currently require physicians to help patients manage weight as a pathway to health improvement and those patients who struggle with weight and would derive health benefits from weight loss are candidates for medications.

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Finally, if patients have success with a medication and lifestyle change to produce weight loss, the medication should be continued to maintain weight loss. Since weight regain is an issue when medications are stopped, restarting medications is also appropriate.

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