News of pharmacological treatment of obesity

Česká verzia

Authors: Šrámková P.
Authors place of work: OB klinika, Praha
Published in the journal: Gastroent Hepatol 2018; 72(6): 495-500
Category: Obezitologie a bariatricko-metabolická chirurgie: původní práce
doi: https://doi.org/10.14735/amgh2018495

Summary

Weight reduction can improve comorbidities and reduce risk factors in obese individuals and requires a comprehensive and individual approach. Pharmacotherapy of obesity is eligible to individuals who do not respond satisfyingly to changes in dietary and exercise regime. Pharmacotherapy is recommended for patients with body mass index (BMI) ≥ 27 and associated comorbidities or with BMI ≥ 30. Excluding Orlistat, the effect of antiobesitic medication is to reduce the food intake through changes in appetite and feeling of hunger. Treatment can be continued if weight loss after 3 months is ≥ 5% of the individual’s original weight, without undesirable effects. In the Czech Republic, obesity is treated with orlistat, limited prescription phentermine for short-term use, a new bupropion-naltrexone combination drug, and injectable liraglutide (available from November 2018) at a dosage of 3 mg/ d. GLP-1 analogues and SGLT-2 blockers are recommended for treatment of diabetes, along with their antidiabetic impact, they improve the blood glucose level and support weight loss. There is a broader range of options in the USA. In addition to already mentioned medication there is lorcaserin, the combination of phentermine and bupropion, pramlintide and bromocriptine for patients with T2DM. Currently available anti-obesity drugs lead to weight reductions averaging 5– 10% of the individual’s original weight per year. Orlistat has the smallest effect (– 2.9 kg/ year), but the least adverse effects. The phentermine/ topiramate combination has the greatest effect (– 10.2 kg/ year). The etiology of obesity combines genetic and environmental factors and influences the patient throughout his life. Alike other chronic diseases such as hypercholesterolaemia or hypertension, the obesity treatment is for lifelong. The short-term therapy results in the yo yo effect. Contraindications should be respected when prescribing anti-obesity drugs, and obese individuals should be educated about the need to reduce food intake and increase physical activity.

Key words:

obesity – pharmacotherapy – orlistat – combination of bupropion and naltrexone – liraglutide

Submitted: 22. 9. 2018

Accepted: 10. 10. 2018

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

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