Authors
Benny PV1
1Chief Editor, Kerala Medical Journal; Professor, Department of Community Medicine, Sree Gokulam Medical College, Kerala, India.
Abstract
Background: Obesity is a leading global cause of early morbidity and mortality, associated with numerous co-morbidities including type 2 diabetes, heart disease, stroke, and sleep apnoea. Treatment strategies involve lifestyle modification, antiobesity drugs, and bariatric surgery, with the primary goal of improving or preventing metabolic complications, not just weight loss.
Pharmacotherapy: Non-pharmacologic methods are the first approach. If inadequate weight loss is achieved through lifestyle intervention for 3-6 months, pharmacotherapy can be considered. Approved long-term drugs include Orlistat, lorcaserin, and the combination of phentermine and topiramate. Short-term use drugs (up to 12 weeks) include benzphetamine, diethylpropion, phendimetrazine, and phentermine. Sibutramine was previously prescribed but withdrawn due to cardiovascular events.
Efficacy and Safety: Orlistat partially blocks fat digestion. Lorcaserin, a serotonin 2C receptor agonist, is approved for long-term use and has shown effective weight loss with a favorable safety profile in clinical studies. Phentermine, typically used short-term, provides an average additional weight loss of 3.6 kg over placebo. The combination of phentermine/topiramate yields a mean weight loss of 8-10 kg, utilizing lower doses of each component. Patient side effects are a critical consideration in drug selection.
Conclusion: As obesity is a major non-communicable risk factor, its management is paramount for public health. A comprehensive approach integrating both non-pharmacological and pharmacological methods is essential to effectively address this health hazard.