In a 45-year-old woman with morbid obesity, severe anxiety, uncontrolled hypertension, and a history of a medullary thyroid carcinoma, which obesity medication would be most appropriate?

• A. Orlistat
• B. Phentermine
• C. Naltrexone
• D. Liraglutide

Answer: (A)

When choosing an obesity medication, safety in the patient’s comorbid conditions is the priority. In this scenario, symptoms like uncontrolled hypertension and severe anxiety mean you want a drug that won’t raise blood pressure or worsen anxiety, and you also must avoid medicines associated with medullary thyroid carcinoma.

Orlistat fits these needs because it works locally in the gut by inhibiting pancreatic lipase, reducing fat absorption without causing systemic cardiovascular or central nervous system effects. This makes it safer for someone with uncontrolled hypertension and anxiety compared with stimulants or CNS-acting agents. It also avoids the thyroid-cancer risk seen with GLP-1 receptor agonists, which are contraindicated in a history of medullary thyroid carcinoma.

Keep in mind orlistat can cause gastrointestinal side effects (steatorrhea, oily stools) and may interfere with fat-soluble vitamin absorption, so a multivitamin taken separately is often recommended. Other options would either raise blood pressure or anxiety (phentermine), have potential cardiovascular or mood effects (naltrexone/bupropion), or be contraindicated due to medullary thyroid carcinoma risk (liraglutide).