doi: 10.23137/AOM24.03.RA0008 Citation BibTeX RIS Mendeley

Personalized Anti-Obesity Medication Selection for Individuals with Comorbidities

동반질환에 따른 비만 약제의 선택

• Hae-Jin Ko (Department of Family Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu)
• Yoon Jeong Cho (Department of Family Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu)
• Kyoung-Kon Kim (Department of Family Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon)
• Kang Jee-Hyun (Department of Family Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea)

Obesity is a complex multifactorial condition that is associated with increased risk of various diseases and higher all-cause mortality. It contributes to the development of numerous comorbidities and adverse clinical outcomes, and is reciprocally influenced by certain medical conditions, further complicating effective weight management. Key management strategies include diet, physical activity, and behavioral interventions, with pharmacotherapy and bariatric surgery serving as adjuncts to enhance weight loss and improve long-term maintenance. As of 2024, several anti-obesity medications (AOMs) have been approved in Korea, including orlistat, naltrexone/bupropion, phentermine/topiramate, and nutrient-stimulated hormone (NuSH)-based AOMs such as liraglutide, semaglutide, and tirzepatide. The selection of AOMs requires careful consideration of individual comorbidities to optimize therapeutic outcomes, while minimizing adverse effects. For patients without comorbidities, all AOMs are viable options. NuSH-based AOMs are primarily recommended for patients with type 2 diabetes or prediabetes because of their superior efficacy, though other AOMs may also be considered. For individuals at high risk of cardiovascular disease, NuSH-based AOMs with proven effectiveness in reducing major adverse cardiovascular events are preferred. In patients with psychiatric disorders, all AOMs should be used with caution and under close monitoring. AOMs are contraindicated in patients with severe hepatic or renal impairment and in pregnant or breastfeeding women. Personalized, comorbidity-focused pharmacological strategies are essential to achieve significant and sustainable weight loss. This review examines the role of tailored pharmacotherapy in obesity management, and emphasizes the importance of individualized treatment approaches to address the unique health profiles of individuals with obesity and improve therapeutic outcomes.