Bariatric Pharmacotherapy
The use of medications to treat obesity, distinct from bariatric surgery. The GLP-1 receptor agonist class has dramatically expanded bariatric pharmacotherapy options, with semaglutide 2.4mg (Wegovy) and tirzepatide (Zepbound) producing weight losses previously only achievable with surgical intervention.
Technical Context
Historical anti-obesity drugs: fenfluramine/phentermine (withdrawn 1997, valvular heart disease), sibutramine (withdrawn 2010, cardiovascular risk), rimonabant (withdrawn 2009, psychiatric adverse effects). Currently approved: orlistat (lipase inhibitor, ~3% weight loss), phentermine-topiramate ER (~10%), naltrexone-bupropion ER (~5%), and the new peptide class — semaglutide 2.4mg (~15%), tirzepatide (~22.5%). The GLP-1 RA/incretin class has transformed bariatric pharmacotherapy from modestly effective (~3-5% weight loss) to substantially effective (15-25%), creating a viable alternative to bariatric surgery for many patients. Emerging pipeline: triple agonists (retatrutide, ~24% in Phase II), oral GLP-1 RAs (higher-dose oral semaglutide, ~15% in Phase III), amylin analogues (cagrilintide + semaglutide combination, ~22% in Phase II), and bimagrumab (activin receptor antagonist, preserved lean mass).