and other specialties based on the prevalence of obesity, the authors suggested. To increase fair access to obesity treatment, it’s criti- cal to have a patient-centered approach that aligns clinical goals with individual preferences and tolerability, accord- ing to the review. The accessibility and affordability of first- generation obesity medications make them essential tools for broadening equitable cardiometabolic care, but more clinicians need to have the expertise to achieve success with the full collection of obesity medications, the authors concluded. The VA has specific guidance for the use of the follow- ing weight loss medications: • phentermine/topiramate (Qsymia), • orlistat (Xenical, Alli), • naltrexone/bupropion (Contrave), • liraglutide (Saxenda), • semaglutide (Wegovy), or • tirzepatide (Zepbound). A chief requirement is that pharmacotherapy with weight management medications “should always be in conjunction with a comprehensive lifestyle intervention (i. e. , clinically supported weight management program that targets all three aspects of weight management: behav- ioral, dietary, physical activity). ” The guidance from the VA Pharmacy Benefits Management Services and National Formulary Committee, updated in August 2025, noted that the MOVE! Weight Management Program offers a compre- hensive lifestyle intervention and operational definition of comprehensive lifestyle intervention in VA. “Weight management medications can be initiated any time during participation in a comprehensive lifestyle intervention,” according to the guidance. “The optimal duration for use of a weight management medication and outcomes beyond 2 to 4 years have not been established. Weight man- agement medications should be viewed as long- term therapy, as short- term use results in weight regain. ” The VA pointed out that long-term use of more than a year, “while not always associated with additional weight loss, results in significantly less weight regain compared to lifestyle inter- ventions alone. It is also possible that long term use can improve other comorbid conditions. ” The document also provides some suggestions to clini- cians on selecting a weight management medication and said that a number of factors must be considered including each drug’s efficacy, side effects, cautions, warnings, the patient’s comorbidities. It also emphasizes shared deci- sion-making should involve the patient and provider. “If sufficient weight loss is not achieved within the first 3 months of a maximally tolerated dose of a pharmaco- therapy or significant weight gain or regain after initial loss occurs, then the weight management medication should be discontinued,” the VA advises. “A trial of a different weight management medication may be warranted pro- vided the patient continues to adhere to comprehensive lifestyle intervention. ” The VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity suggests that weight management medications for long-term weight loss be offered to patients with a body mass index greater than 30 kg/m2 and to those with a BMI > 27 kg/m2 who also have obesity associated conditions, in conjunction with comprehensive lifestyle intervention. Six weight management medications are FDA approved for chronic weight management. Phentermine/topiramate, naltrexone/bupropion and orlistat are available on VA National Formulary with Prior Authorization at the Facility level with Criteria for Use; semaglutide, tirzepatide and lira- glutide are available by nonformulary request. 1 Schmitz SH, Saunders KH. A Review of First-Generation Obesity Medications. Curr Atheroscler Rep. 2026 Jan 22;28(1):14. doi: 10. 1007/s11883-026-01389-0. PMID: 41569 475. 9 0 Source: VA Pharmacy Benefits Management Services and National Formulary Committee Medication Initial Weight Loss and Weight Maintenance Goals
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