A Role for Emerging Obesity Drugs
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INVITED COMMENTARY
A Role for Emerging Obesity Drugs Goutham Rao
Published online: 12 February 2012 # Springer Science+Business Media, LLC 2012
Abstract Obesity is an intractable, global health problem. A variety of strategies, including behavioral programs, surgery, and changes in the built environment and public policy can play an important role but have significant limitations. Medications to promote weight loss have been available for many years, though the number of currently available drugs is very limited. Promising medications have suffered from concerns about serious side effects, as evidenced by market withdrawals of fenfluramine-phentermine, sibutramine, and rimonabant. Emerging weight loss medications include single or combination agents. Single agents include the diabetes drugs exenatide, pramlintide, and liraglutide, all associated with significant weight loss. None of these are currently approved for the treatment of obesity in the absence of diabetes. Combination therapy involves combining two currently available medications whose safety profiles have been well established, with the expectation of a synergistic weight loss effect. Naltrexone SR/buproprion SR and phentermine IR/topiramate CR are two combination drugs closest to approval and widespread availability. No drug is likely to have an extremely important large impact upon weight. Nevertherless, given that even modest weight loss in obese individuals (roughly 5% of body weight) can have a significant impact upon obesity-related illness, emerging weight loss drugs can play a role in supplementing lifestyle modifications, especially in patients who have successfully implemented some modifications but are still struggling to lose weight.
G. Rao (*) Department of Family Medicine, NorthShore/University of Chicago, 1001 University Place, Suite 138, Evanston, IL 60091, USA e-mail: [email protected]
Keywords Obesity . Drug therapy . Naltrexone . Topiramate . Bupropion . Phentermine
Illustrative case: Harold is a 63-year-old obese man who was diagnosed with type 2 diabetes approximately 5 years ago. He is currently taking the maximum dose of metformin, but his glucose control is deteriorating. He wishes to avoid taking additional medications, especially insulin. Three months ago he began an exercise regimen consisting of daily walking for 30 to 40 minutes. Although he has followed this regimen faithfully, Harold has neither lost weight nor improved control of his diabetes. He has grown increasingly frustrated and wonders if weight loss and improved health are even possible for him. In much of the world, obesity represents one of the major threats to public health in the 21st century. It is a challenging problem to prevent and an intractable one to reverse. Currently available strategies suffer from significant limitations. Behavioral programs designed to promote healthier eating and more physical activity can be effective, but have high attrition rates, are expensive and difficult to implement, and are not widely available. Bariatric surgery is
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