Î ES recommends ACE inhibitors, angiotensin receptor blockers (ARBs), and
calcium channel blockers rather than β-adrenergic blockers as first-line
therapy for hypertension in patients who are obese with T2DM. (1|⊕⊕⊕⊕)
Î When antidepressant therapy is indicated, ES recommends a shared
decision-making process that provides patients with quantitative estimates
of the expected weight effect of the antidepressant to make an informed
decision about drug choice. Other factors that need to be taken into
consideration include the expected length of treatment. (1|⊕⊕⊕
)
Î ES recommends using weight-neutral antipsychotic alternatives when
clinically indicated rather than those that cause weight gain, and the use of
a shared decision-making process that provides patients with quantitative
estimates of the expected weight effect of the alternative treatments to
make an informed decision about drug choice. (1|⊕⊕⊕
)
Î ES recommends considering weight gain potential in choosing an
antiepileptic drug for any given patient, and the use of a shared decision-
making process that provides patients with quantitative estimates of the
expected weight effect of the drugs to make an informed decision about
drug choice. (1|⊕⊕⊕
)
Î In women with a BMI >27 kg/m
2
with comorbidities or >30 kg/m
2
seeking contraception, ES suggests oral contraceptives over injectable
medications due to weight gain with injectables, provided that women are
well-informed about the risks and benefits (i.e., oral contraceptives are not
contraindicated). (2|⊕
)
Î ES suggests monitoring the weight and waist circumference of patients
on antiretroviral therapy due to unavoidable weight gain, weight
redistribution, and associated cardiovascular risk. (2|⊕⊕⊕
)
Î ES suggests the use of NSAIDs and disease-modifying antirheumatic drugs
(DMARDs) when possible in patients with chronic inflammatory disease
like rheumatoid arthritis, since corticosteroids commonly produce weight
gain. (2|⊕⊕⊕
)
Î ES suggests the use of antihistamines with less central nervous system
activity (less sedation) to limit weight gain. (2|⊕⊕
)
Off-Label Use of Drugs Approved for Other Indications for
Chronic Obesity Management
Î ES suggests against the off-label use of medications approved for other
disease states for the sole purpose of producing weight loss. A trial of
such therapy can be attempted in the context of research, and by health
care providers with expertise in weight management dealing with a well-
informed patient. (U)
