Drug Therapy for Obesity
European
Family Physician
May, 2008
Obesity is a common health problem in the
Europe, and effective treatment is challenging. Obesity is
associated with an increased mortality rate and risk factors
such as hypertension, hyperlipidemia and diabetes mellitus.
Numerous treatments are available for obesity. Behavioral
therapy, surgery and pharmacologic treatment have been used with
varying degrees of success. market because of a possible
association with cardiovascular complications. The safety of
newer agents must be extensively evaluated before widespread use
is recommended. Therefore, behavioral therapy, including regular
exercise and the development of healthy eating habits, continues
to be the best treatment for long-term weight loss.
Obesity is one of the most common and
serious health problems in Europe. Excess weight is
independently associated with an increased mortality rate in
multiple conditions Approximately one fourth of European adults
(more than 60 million people) are overweight.
Etiology of Weight Loss
I
n
most persons, being overweight is primary--no obvious cause
exists other than an imbalance in energy intake and expenditure.
Medical disorders such as Cushing's syndrome, hypothyroidism and
hypogonadism rarely cause obesity. Genetic factors play a role,
but the specific mechanism is unclear. Recently, a mutation in
the gene coding for the beta3-adrenergic receptor has been found
to be associated with an increased capacity to gain weight in
some morbidly obese persons. In theory, low
beta3-adrenergic activity could promote obesity by slowing
lipolysis, causing retention of lipids in fat cells. Regardless
of recent developments in understanding this problem, obesity
should be considered a condition with multiple causes. Genetic,
cultural, socioeconomic, behavioral and situational factors all
play a role in dietary habits and weight control.
Weight Loss Evaluation
Assessment of the overweight person should
begin with a careful history and physical examination. The
patient's weight history from childhood should be reviewed,
including various methods of weight loss that have been
attempted and the results of each attempt. Activity level and
dietary history should also be reviewed. Because weight gain is
a common side effect of certain medications, a history of
medication use is an important aspect of the initial evaluation.
Weight gain is also common during the initial phases of smoking
cessation.
Assessment of Body Mass Index (BMI) Very
Important
Body weight for height, gender and
body-frame size has traditionally been used as the fundamental
assessment of obesity. The National Institutes of Health and the
National Heart, Lung, and Blood Institute recommend that all
adults receive periodic measurement of height and weight by body
mass index (BMI = weight in kilograms divided by height in
meters squared) using standard tables (Figure 1)(8) of suggested
weights, along with the assessment of other factors such as
medical conditions or waist-to-hip circumference ratio, as a
basis for further evaluation, intervention or referral to
specialists.
"Overweight" is defined as a BMI of 25.0
to 29.9 kg per m2, and "obese" is defined as a BMI greater than
30 kg per m2.2 It may be useful to determine the distribution of
body weight between fat and lean body mass in some patients
attempting to lose weight; however, the effectiveness of these
measurements in all patients is unknown.
Weight Loss Treatment
Tenuate, Appetite Suppressants
Various pharmacologic agents, referred to as
anorectic drugs, are used as adjuncts to behavioral therapy in
weight reduction programs. These so called, appetite
suppressants have proved to be very effective.
Tenuate is structurally similar
to amphetamine and modulates noradrenergic neurotransmission to
decrease appetite; however, it has little or no effect on
dopaminergic neurotransmission, which decreases its potential
for abuse.
In clinical trials, the use of
Tenuate alone resulted in
significant weight loss when compared with placebo (sugar pill).
Individuals that included
Tenuate in their healthy weight
loss plan lost 2-3 times more weight than those individuals that
attempted dieting without
Tenuate.
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Xenical, Digestive Inhibitors (fat
blockers)
Another strategy in the treatment of obesity
is to use digestive inhibitors that interfere with the
breakdown, digestion and absorption of dietary fat in the
gastrointestinal tract. A reduction in fat is recommended in
most weight loss diets; however, patient compliance with these
diets is generally poor. Therefore, digestive inhibitors may
have a role in creating the negative energy balance necessary
for subsequent weight loss.
Gastric and pancreatic lipases aid in the
digestion of dietary triglycerides by forming them into free
fatty acids that are then absorbed at the brush border of the
small intestine. IXenical, the first lipase inhibitor labeled
for treatment of obesity, is a potent and irreversible inhibitor
of gastric and pancreatic lipases, preventing the absorption of
about 30 percent of dietary fat.
Xenical similar to Tenuate promoted successful weight loss.
Most individuals that combined Xenical with their dieting
efforts loss close to two times more weight than those
individuals that attempted to diet without Xenical.
Final Comments Concerning Weight Loss
Pills
If drug therapy is recommended in the
management of obesity, it should be used in combination with a
structured diet and an exercise program to achieve the greatest
and longest lasting results. Two weight loss medications have
been proven in clinical trials to promote weight loss,
Tenuate (click here for details) and
Xenical (click here for details).
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How Can I Lose Weight?
European Family Physician
May, 2008
What causes weight gain?
We gain weight when we take in more calories
than we burn off with exercise. Unless lean muscle is built by
exercise, weight gain means mostly more body fat. In some cases,
weight gain may also relate to our genes, the environment, our
psychological state and other factors.
How much weight should I try to lose?
Talk to your doctor about your current
weight and a healthy weight loss goal. You can improve your
health a lot by losing as little as 5 to 10% of your present
body weight. You should lose no more than about 1 pound a week.
When you lose weight this slowly, you are more likely to keep it
off.
What can I do to lose weight?
To lose body fat, you should eat fewer
calories and increase your exercise. This may help you gain lean
muscle to replace some of the fat you are losing. Your doctor
can help you find a dietitian who can help you choose what to
eat. Your doctor can also recommend an exercise plan for you.
You should try to get 30 to 60 minutes of exercise, 4 to 6 times
a week.
Do weight loss pills help?
Weight loss pills will help you lose
weight, but only when they are combined with a low-calorie diet
and an exercise plan. Tenuate Dospan has been shown in numerous
clinical trials to promote fast weight loss. Tenuate Dospan will
decrease both your appetite and your cravings for high caloric
foods.
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Who should use weight loss medicines?
Weight-loss medicines are only for people
who are considered to be over weight . Those individuals who
weigh about 20% more than the ideal for their height and body
type. These medicines are not for people who just want to lose 2
to 3 pounds. Your doctor can tell you if weight loss medicines
might help you.
How can I keep weight off when I stop
using the medicine?
Weight gain is common after the medicine is
stopped. To keep the weight off you must permanently change your
food and exercise habits. Remember, losing weight and keeping it
off is a life-long effort.
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