Background

Many medications impact weight and may contribute to the obesity epidemic. The healthcare community needs updated information about commonly prescribed medications that impact weight and any alternative weight-neutral medications for patients at risk for obesity.

Methods

Medications among a list of the most commonly prescribed medication classes published by Centers for Disease Control (CDC) were identified in an electronic health record (EPIC Systems serving both children/adults). Two independent reviewers looked up each medication in two drug databases (Micromedex/Lexicomp) for evidence of impact on weight. Each medication was categorized by (a) association with weight loss, gain, both, or neither/no weight mention; and (b) percent of patients who experienced weight change when using the medication (>1%, ≤1%, or unknown). Discrepancies were resolved by re-referencing drug databases, consensus, and consultation with multidisciplinary content experts. The experts then reviewed the drug list and suggested additional medications to consider, which were reviewed by the same process. Expert consensus finalized the lists of medications associated with weight loss, gain, both, or neither.

Results

Medications that impact weight were identified in 22 of 28 (79%) of the most commonly prescribed medication classes per CDC, and 25% (n=278) of 1,106 medications reviewed. Of medications impacting weight, 47% (n=131) were linked to weight gain, 31% (n=87) to weight loss, and 22% (n=60) to both. Over half (52-53%) of medications identified as impacting weight were reported to impact weight in >1% of patients taking the medication.

Conclusions

Twenty five percent of commonly prescribed medications impact weight. Almost half of these medications promote weight gain and may contribute to obesity. Use of alternative, clinically indicated medications that are weight neutral or linked to weight loss could reduce iatrogenic weight gain. Decision support tools to easily access this information are under development.