My dr's have never prescribed me anything and I've been obese my whole adult life. I am loath to bring it up and I think maybe they feel like I have so much to lose that it would be bad to put me on pills for that long? I have seen people who are merely overweight be put on pills though. I think its an individual thing and depends on your health, what other meds you are taking, your personality and current mental and emotional health.
I also notice they don't really promote or suggest weight loss surgery to me either. When I know people half my size get it done all the time (again I am petrified of surgery so I've never brought it up).
I'm okay with that though, I've finally reached a place where albeit SLOWLY I'm losing weight (in the grand scheme of things.. the past 4 months I haven't lost a lb but... in general I'm finally under 300lbs, and before that I had "permanently" {3+ years} lost 20 or so lbs... Even if I keep losing 20 to 30lbs a year and keeping it off in the long run that works better for me than dropping 50lbs in 3 months, and then regaining it all and then some when I fell off the wagon into the ravine
Who knows maybe they sense I'm not really open to the idea. I am sure it works and helps other people but I feel like I'd be one of those people who broke the rules and would screw things up anyhow.