Abstract

Obesity is a complex, multifactorial condition associated with increased risks 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. Core management strategies include dietary, 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 e.g., liraglutide, semaglutide, and tirzepatide. 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 due to their superior efficacy, though other AOMs may also be considered. For individuals at high risk of cardiovascular disease, NuSH-based AOMs with demonstrated efficacy 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 explores the role of tailored pharmacotherapy in obesity management, emphasizing the importance of individualized treatment approaches to address the unique health profiles of individuals with obesity and improve therapeutic outcomes.