Pharmacotherapy for adults with overweight and obesity

Although Qingyang Shi and colleagues’ systematic review and network meta-analysis of pharmacotherapy for overweight and obesity1Shi Q Wang Y Hao Q et al.Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials.Lancet. 2022; 399: 259-269Summary Full Text Full Text PDF PubMed Google Scholar appears well conducted, we believe that the interpretation of the findings is not person-centred, and is perhaps even misleading, for several reasons. Their stated aim is to summarise the “benefits and harms of weight-lowering drugs”, but the main findings and discussion focus on weight loss, without due consideration to the scarcity of evidence for benefits to health and wellbeing. For instance, quality of life and depression data are reported as low quality or insufficient, and there is no mention of the absence of long-term cardiovascular outcomes. A review on long-term effects of weight-reducing pharmacotherapy included only one trial with cardiovascular outcomes; it found no benefit.2Siebenhofer A Winterholer S Jeitler K et al.Long-term effects of weight-reducing drugs in people with hypertension.Cochrane Database Syst Rev. 2021; 1CD007654 PubMed Google Scholar Similarly, we believe the documented medication harms are given insufficient attention in their report. This could influence the main message of the report, especially for readers who do not look beyond the abstract. Other potential harms not considered include cost, stigma,3Phelan SM Burgess DJ Yeazel MW Hellerstedt WL Griffin JM van Ryn M Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.Obesity Reviews. 2015; 16: 319-326Crossref PubMed Scopus (485) Google Scholar and the effect on eating habits, nutritional adequacy, and interpersonal relationships. We note that the multidisciplinary panel had no patient representation. Finally, there is no information on the funding of studies within the analysis despite the well documented influence of pharmaceutical funding of research.4Moynihan R Bero L Hill S et al.Pathways to independence: towards producing and using trustworthy evidence.BMJ. 2019; 367l6576 PubMed Google Scholar We strongly advocate for data showing long-term health and wellbeing benefits of pharmacotherapy, use of standardised outcomes for obesity-related research,5Mackenzie RM Ells LJ Simpson SA Logue J Core outcome set for behavioural weight management interventions for adults with overweight and obesity: standardised reporting of lifestyle weight management interventions to aid evaluation (STAR-LITE).Obesity Reviews. 2020; 21e12961 Crossref PubMed Scopus (12) Google Scholar and involvement of people of higher weight in decisions about what matters most. Person-centred care requires balanced information on benefits and harms of different treatment approaches to allow informed shared decision making. We declare no competing interests. TES and LB are supported by the National Health and Medical Research Council, unrelated to this Correspondence. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trialsIn adults with overweight and obesity, phentermine–topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective. Full-Text PDF Pharmacotherapy for adults with overweight and obesity – Authors' replyWe agree with Elizabeth Sturgiss and colleagues that patient-centred care is crucial, which is why it is represented in the performance of the systematic review and meta-analysis.1 The patient-centred approach is never a one-size-fits-all without case-to-case consideration. Targeting adults with overweight and obesity who are seeking weight-lowering therapy, the multidisciplinary panel determined to support the decision making with a 1-year timeframe. The decision is in line with real-world practice and is supported by a parallel qualitative patient focus group study that informs the panel with patients’ values and preferences (Jing Li and colleagues, unpublished). Full-Text PDF