Obesity
Chronic disease with excess adipose tissue and BMI ≥ 30 kg/m². Foundation: lifestyle change (diet, physical activity, behavioral therapy). If insufficient — pharmacotherapy (GLP-1 agonists, tirzepatide, orlistat) and bariatric surgery on indication.
ICD-10 E666 drugs
Drugs used for this condition
- ALiraglutideSecond line · Glucagon-like peptide-1 (GLP-1) receptor agonistFor obesity, liraglutide (Saxenda) is used at 3 mg subcutaneously once daily. The SCALE Obesity and Prediabetes trial showed weight loss of 8% at 56 weeks versus 2.6% on placebo. AACE/ACE 2024 and SEEDO 2024 indicate obesity pharmacotherapy at BMI ≥30 or BMI ≥27 with comorbidities after lifestyle change failure. Semaglutide and tirzepatide produce greater weight loss with less frequent injections.
- ASemaglutideFirst line · GLP-1 receptor agonistsSemaglutide 2.4 mg weekly (Wegovy in the US and EU) is approved for obesity in adults with BMI ≥ 30, or ≥ 27 with comorbidities. STEP-1 (1,961 patients) showed 14.9 % weight loss over 68 weeks vs 2.4 % on placebo. Wegovy is not registered in Russia; obesity treatment uses Ozempic off-label or Saxenda (liraglutide). Approved in adolescents 12–17 years with obesity per STEP-Teens. Benefits persist only with continued therapy – two thirds of weight returns within a year after discontinuation.
- ATirzepatideFirst line · Blood glucose lowering drugs, GLP-1 and GIP receptor agonistsTirzepatide as Zepbound is FDA-approved (November 2023) and EMA-approved (August 2024) for adult obesity with BMI ≥30 or BMI ≥27 with comorbidities. The SURMOUNT programme: SURMOUNT-1 (Jastreboff 2022, n=2539, 72 weeks) showed 15–21% weight loss vs 3% on placebo across 5/10/15 mg doses; SURMOUNT-2 in type 2 diabetes patients (Garvey 2023) and SURMOUNT-3 after intensive lifestyle intervention (Wadden 2023). Efficacy exceeds semaglutide (Wegovy 2.4 mg) in indirect comparisons. AACE 2023 and Obesity Society 2024 guidelines list tirzepatide as first-line. Use requires gradual dose titration due to GI side effects.
- BOrlistatSecond line · Peripherally acting antiobesity drug – intestinal lipase inhibitorObesity with BMI ≥30 or BMI ≥27 with risk factors (type 2 diabetes, dyslipidemia, hypertension) when 6 months of lifestyle modification have not produced ≥5% weight loss. Per EASO 2024 and SEEN 2023 – second-line after diet, physical activity, and behavioral therapy. Dose: 120 mg three times daily with or within one hour of a fat-containing meal. Skip the dose if the meal is fat-free. Effect at 4–6 weeks; discontinue if weight loss <5% by 12 weeks.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DInulin (chicory/agave/Jerusalem artichoke prebiotic)Not recommended · Soluble fructan fibre, prebiotic. Supplement in Russia and Spain. EFSA approved health claim for chicory inulin on maintenance of normal defecation (2015). AEMPS does not register it as a medicineInulin is sold for weight loss as a «prebiotic appetite control aid». Small RCTs (Parnell 2009, Guess 2015) in 50–100 overweight patients showed modest body weight reductions of 1–2 kg on inulin 16–21 g/day × 12–18 weeks. Effect is modest, not comparable to first-line interventions. ESC/EAS 2024 in obesity (BMI ≥30) lists lifestyle modification (500 kcal/day deficit, 150–300 minutes/week aerobic + resistance training); BMI ≥30 + comorbidities or BMI ≥35 – pharmacotherapy (semaglutide, liraglutide, tirzepatide, bupropion/naltrexone, orlistat); BMI ≥40 or ≥35 + type 2 diabetes – bariatric surgery discussion. Inulin is not in international obesity guidelines. If inulin was recommended as a substitute for a comprehensive weight management programme, consider seeking a second opinion from an endocrinologist or dietitian.
- DMedium-chain triglycerides (MCT, coconut oil C8–C10)Not recommended · Medium-chain fatty acids C8 (caprylic) and C10 (capric), extracted from coconut and palm kernel oil. Supplement. In clinical medicine MCT is used in enteral and parenteral nutrition in malabsorption syndrome, cystic fibrosis and ketogenic diet for drug-resistant epilepsy. AEMPS does not register it as a monoproduct medicineIn obesity (BMI ≥30) MCT is sold as a «natural semaglutide alternative» and essential keto diet component. Meta-analyses showed no clinically meaningful weight reduction in obesity patients adding MCT to diet; effect disappeared on isocaloric replacement of long-chain triglycerides. SEEDO 2022 and NICE 2023 for obesity list as first-line a comprehensive programme (diet, physical activity, behavioural therapy); at BMI ≥30 – GLP-1 receptor agonist pharmacotherapy (semaglutide/Wegovy 2.4 mg/week SC gives mean 15% weight loss at 68 weeks – STEP 1 trial), tirzepatide (Zepbound, SURMOUNT 1 – 21% at 72 weeks), liraglutide, orlistat; at BMI ≥40 (or ≥35 with complications) – bariatric surgery. Keto diet as a weight-loss strategy is not preferred in guidelines: Mediterranean and DASH diets have stronger evidence base and easier long-term adherence. If MCT was recommended as a comprehensive programme substitute in obesity, consider seeking a second opinion from an obesity specialist.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit