Sibutramine, orlistat, phentermine, diethylpropion (probably), bupropion, fluoxetine, and topiramate all promote weight loss when given along with recommendations for diet. Sibutramine and orlistat are the two most-studied drugs. The amount of extra weight loss attributable to these medications is modest (less than 5 kg at one year), but this amount still may be clinically significant. No evidence indicates that any particular drug promotes more weight loss than another drug. All of these drugs have side effects. The choice of drug may be made on an individual basis, based on tolerance to the expected side effects.
Surgical treatment is more effective than nonsurgical treatment for weight loss and the control of some comorbidities in patients with a body mass index of 40 kg/m2 or greater. More data are needed to confirm or refute the relative efficacy of surgery for less severely obese persons. Perioperative mortality rates of less than 1 percent have been achieved by some surgeons and surgical centers. The perioperative mortality rates in other settings may be higher. Surgical treatment is associated with a substantial number of complications and adverse events, although most of these are minor.
The existing literature is almost bereft of data regarding either pharmaceutical or surgical treatment of adolescent and pediatric patients. To the extent that existing data on adults are judged to be inapplicable to adolescents or children, new studies will need to be performed.