Medication for Obesity: A Swift Synopsis

Join us for a rapid-fire review of a groundbreaking study published in The Lancet by McMaster University. Explore the latest insights on weight loss treatments alongside esteemed scholars like Gordon Guyatt and Per Van Vick. With Dr. Goldenberg guiding us through the study's complexities, we quickly unpack findings from 143 trials involving nearly 50,000 participants. Witness the clash of heavyweight medications like the fentermine-topiramate combo, GLP-1 agonists, and naltrexone-bupropion duo, as they vie for supremacy in the battle against obesity. Don't miss out on this fast-paced discussion shedding light on the efficacy and safety of these interventions, offering clarity in the realm of weight loss treatments.

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Episode Transcript

Introducer (00:02):
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but go ahead and email usdirectly at josh@ drjournalclub.
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Send us your listener questionsand we will discuss it on our
pod.
Hello and welcome to anothersuper speedy summary.
Today we're going to talk aboutmedications for overweight and

(01:17):
obesity.
Impressive networkmeta-analysis coming out of
McMaster University, with GordonGuyot and Per Van Vick and sort
of like all my heroes of theevidence-based medicine world
literally designed the method,like literally wrote the methods
for how to do high qualitysystematic reviews and

(01:38):
meta-analyses, and this isreally really, really cutting
edge.
In fact, it was published inthe Lancet not too shabby, and
so, of course, as everybodyknows, overweight and obesity
are major problems in the US andincreasingly worldwide, and
while diet and lifestyle isalways the first choice for
everybody, clearly it's notsufficient for many, and so the

(01:59):
question is what about theseweight-lowering medications,
these weight loss medications,what are.
The question is what aboutthese weight-lowering
medications, these weight-lossmedications?
What are the overall effectsand safety of these drugs if
used in addition to diet andlifestyle, and their impact on
the body weight of adults whoare overweight and obese?
So this was, like I said, anetwork meta-analysis.

(02:20):
It only included randomized,controlled trials, so really
high quality evidence.
They found 143 randomizedtrials with just about just shy
of 50,000 participants.
This is a huge data set.
And all these studies looked atweight loss medications with
lifestyle recommendationscompared to lifestyle
recommendations, either with orwithout a placebo, looking at

(02:42):
different outcomes around weightloss minimal important
difference with weight loss andsome secondary outcomes as well.
And so what did they find?
So they found that they wereindeed quite helpful large,
minimally clinically importantdifferences in weight, and the
nice thing about a networkmeta-analysis is it can rank
what the best intervention isfor.
So if you're less familiar withnetwork meta-analyses, go ahead

(03:04):
and watch our videos in the EBMskills section of the website.
But essentially, a networkmeta-analysis allows you to
compare the value of one drugcompared to another, instead of
just one drug versus placebo.
So it's much more clinicallyrelevant, and so the outcome of
this was that three medicationssort of scored the best.
One is this combination offentermine and topiramate, the

(03:27):
other is GLP-1 agonist and thenthe third is naltrexone
pupropion combination as well.
Now, if you took medications,you were twice as likely to
experience side effects leadingto discontinuation of the
medication than if you took aplacebo or just lifestyle, and
there were only minimal changes,interestingly, actually, in A1c
, systolic blood pressure andLDL, but there were differences

(03:50):
that were above the minimalclinically important difference
in weight loss.
So this is just a super speedysummary If you'd like to get a
really, really good analysis ofthis.
Dr Sadowski did an excellentjob in our basic level video and
then he goes into more depth inthe in-depth version as well.

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Thank you.
We talked about some reallyinteresting stuff today.
I think one of the things we'regoing to do that's relevant.
There is a course we have on DrJournal Club called the EBM
Boot Camp.
That's really meant forclinicians to sort of help them
understand how to criticallyevaluate the literature, etc.
Etc.
Some of the things that we'vebeen talking about today.
Go ahead and check out the shownotes link.

(04:54):
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I think it might be of interest.
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Introducer (05:24):
Any topics that you'd like us to cover on the
pod, please let us know as well.
Thank you for listening to theDoctor Journal Club podcast, the
show that goes under the hoodof evidence-based integrative
medicine.
We review recent researcharticles, interview
evidence-based medicine thoughtleaders and discuss the
challenges and opportunities ofintegrating evidence-based and
integrative medicine.

(05:45):
Be sure to visitwwwdoctorjournalclubcom to learn
more.