The American Endocrine Society (TES) recently released its first “Clinical Guidelines for the Treatment of Obesity Medications”, providing recommendations on how to prescribe weight loss medications. Dr. Caroline M. Apovian, chair of the guideline writing task force and a member of the Boston University School of Medicine, said, “Although the American Obesity Society (TOS), the American Heart Association (AHA) and the American College of Cardiology (ACC) have jointly published the 2013 Guidelines for the Management of Overweight and Obesity in Adults, which include interventions for obesity through lifestyle, diet, exercise, and surgery, the TES has published a series of guidelines for the treatment of obesity. This includes interventions for obesity through lifestyle, diet, exercise, and surgery. Although weight loss medication was mentioned, it was not elaborated. Only a few weight loss medications were available at the time, so there was very little evidence from randomized clinical trials to inform the guidelines. The American College of Endocrinology published guidelines for the pharmacological treatment of obesity that fill this gap.” The newly released guidelines support the recommendations of the 2013 edition of the TOS/AHA/ACC guidelines for the management of overweight and obese patients and, on that basis, provide a blueprint for obesity pharmacotherapy. Recommendation: To date, six drugs have been approved by the FDA for the treatment of obesity. In addition to orlistat and over-the-counter orlistat, four drugs have been approved in the past two years, including cloxacillin (Belviq, Eisai), phentermine/topiramate (Qsymia, Vivus), cyproheptadine/bupropion (Contrave, Takeda) liraglutide (Swxenda, Novo Nordisk). Even if clinicians choose these weight loss medications at the time of treatment, the guidelines emphasize the importance of diet, exercise, and behavioral modification, suggesting that these lifestyle interventions are all integral to the management of obesity. Through these lifestyle interventions, patients will achieve greater overall weight loss and better weight loss maintenance. The current requirements for prescribing the above FDA-approved weight loss medications are a BMI ≥ 27 kg/m2 with at least one weight-related comorbidity (e.g., diabetes, hypertension) or a BMI ≥ 30 kg/m2. Patients who meet the requirements and are started on medications in a weight management program should be closely followed by the clinician. A face-to-face conversation is the best way to follow up, or if that is not convenient, a web-based follow-up can be used. The Centers for Medicare and Medicaid Services (CMS) are required to follow up as often as 15 times per year. Other highlights of the guidelines: 1. Adherence to medication is required for patients who respond well to medication and lose at least 5% of their original weight after 3 months of treatment. However, if weight loss medications are proven to be ineffective or if patients experience significant adverse effects, these medications should be discontinued and replaced with other medications or other treatments. 2. The guidelines state that some glucose-lowering drugs can increase body weight, so for overweight or obese patients with diabetes, glucose-lowering drugs that have a weight-reducing effect or have no effect on body weight should be chosen as first- or second-line therapy. Metformin remains the first-line treatment of choice. If patients also require a second drug in combination, consider a GLP-1 agonist such as exenatide, liraglutide or pramlintide, and consider an SGLT-2 inhibitor before adding a sulfonylurea or insulin, as all of these drugs can reduce weight while controlling blood glucose. For those patients who are using glucose-lowering drugs with weight-increasing effects, the guidelines also give the corresponding recommendations. 3. For the treatment of hypertension in patients with type 2 diabetes mellitus with obesity, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor antagonists (ARBs) and calcium channel blockers should be preferred, because these drugs have little possibility of increasing body weight. 4. Medications such as antidepressants, antipsychotics, and antiepileptics can affect body weight. Patients should be fully informed during treatment with these medications and the possible effects of each medication on body weight should be assessed in advance. In addition, if these patients require a weight loss medication, bupropion may be preferred. The guidelines also recommend that patients be involved in the decision-making process with their physicians. 5. Phentermine and diethylamphetamine should not be used in patients with poorly controlled hypertension or a history of cardiac disease. For these patients, it is recommended that orlistat or crocaserin be considered, both of which have a significantly lower risk of elevated blood pressure compared to phentermine/topiramate or cyproheptadine/bupropion.