Treatment of Obesity in Patients with Complex Comorbidities

Clinical trials for anti-obesity medications typically exclude patients with other severe physical or psychiatric conditions to ensure they do not confound results. This includes patients who are experiencing organ failure and in need of transplantation and those with significant psychopathology, including eating disorders. It also includes those on complex medication regimens or psychiatric medications, many of which are known to have effects on weight. While these are practical exclusions for clinical trials, it means that we do not have data regarding the safety and efficacy of anti-obesity medications in these populations. The choice of which medication to use should be based on an understanding of their contraindications, interactions with other medication classes, and most common side effects. When treating patients with eating disorders and obesity, best practices should be followed, including prioritizing cognitive behavioral therapy, deprioritizing the weight loss and the number on the scale, and focusing on overall health improvements.