Which pharmacological options are available for weight management in adults, and what are their indications?

Pharmacological options for weight management in adults primarily include orlistat, which is licensed for use in adults with a BMI of 28 or higher when used alongside a hypocaloric diet. Orlistat works by inhibiting gastrointestinal lipases, reducing fat absorption, and is indicated for weight loss and maintenance in people with overweight or obesity, particularly those at high risk of type 2 diabetes or cardiovascular disease. Treatment with orlistat should be reviewed after 12 weeks; if the patient has not lost at least 5% of their original body weight, discontinuation should be considered. Long-term use beyond 12 months is possible but requires discussion of benefits, limitations, and side effects with the patient. Side effects mainly include gastrointestinal symptoms related to fat malabsorption, and patients should be advised to follow a low-fat diet to minimize these effects ¹.

Other pharmacological agents such as GLP-1 receptor agonists (e.g., liraglutide) have emerged as effective options for weight management, especially in adults with obesity and comorbidities like type 2 diabetes. These agents promote satiety and reduce appetite, leading to significant weight loss. Although not detailed in the UK NICE guidelines provided, recent literature supports their use as adjuncts to lifestyle interventions in appropriate patients (Apperley et al., 2022). However, their use should be tailored to individual clinical circumstances and local prescribing policies.

In summary, orlistat remains the main pharmacological agent recommended by UK guidelines for weight management in adults, particularly those at high risk of type 2 diabetes, with clear criteria for initiation, monitoring, and continuation. Emerging therapies such as GLP-1 receptor agonists are gaining recognition for their efficacy but require further integration into UK clinical pathways (Apperley et al., 2022; ¹).