Relación entre el fármaco semaglutida y la reducción de peso en pacientes con obesidad: una revisión sistemática / Relation between the drug semaglutide and weight reduction in patients with obesity: a systematic review / Relação entre a droga semaglutida e a perda de peso em pacientes obesos: uma revisão sistemática

El tratamiento farmacológico para la obesidad es muy limitado, entre los existentes en el mercado, destaca la Semaglutida, ampolla subcutánea que se aplica semanalmente y se usa en pacientes con diabetes y obesidad. OBJETIVO: establecer la relación de Semaglutida como un potencial fármaco para el tratamiento de obesidad. MÉTODO: estudio de tipo descriptivo, principalmente enfocado en la revisión y análisis de investigaciones publicadas en bases de datos científicas de alta relevancia, restringiéndose únicamente a publicaciones del 2015 en adelante (2022) que engloben como tópico principal el uso de Semaglutida. RESULTADO: se identificaron 802 registros en las bases de datos, aplicando los criterios de selección se identificaron 45 artículos como potenciales fuentes de información, finalmente se seleccionaron 15 artículos con datos altamente relevantes para esta revisión, donde se consideró la dosis del fármaco para la reducción de peso se observa que a mayor cantidad de Semaglutida se obtiene una reducción significativa de peso, llegando a una media de 11.82 kg. CONCLUSIÓN: el tratamiento semanal con Semaglutida administrada a nivel subcutánea con cambios en el estilo de alimentación y actividad física, dan como resultados pérdida de peso sostenida en el tiempo clínicamente relevante, pudiendo llegar a la aplicabilidad en pacientes cuyo tratamiento por otros métodos más convencionales no es eficiente.

Pharmacological treatment for obesity is very limited; among those available on the market, Semaglutide, a subcutaneous ampoule applied weekly and used in patients with diabetes and obesity, stands out. OBJETIVE: to establish the relationship of Semaglutide as a potential drug for the treatment of obesity. METHOD: descriptive study, mainly focused on the review and analysis of research published in scientific databases of high relevance, restricting only to publications from 2015 onwards (2022) that include as main topic the use of Semaglutide. RESULT: 802 records were identified in the databases, applying the selection criteria 45 articles were identified as potential sources of information, finally 15 articles were selected with highly relevant data for this review, where the dose of the drug for weight reduction was considered, it is observed that the greater the amount of Semaglutide a significant weight reduction is obtained, reaching a mean of 11.82 kg. CONCLUSION: weekly treatment with Semaglutide administered subcutaneously with changes in eating style and physical activity, results in clinically relevant sustained weight loss over time, being able to reach applicability in patients whose treatment by other more conventional methods is not efficient.

Entre os tratamentos existentes no mercado, destaca-se Semaglutide, uma ampola subcutânea que é aplicada semanalmente e utilizada em pacientes com diabetes e obesidade. OBJETIVO: estabelecer a relação do Semaglutide como uma droga potencial para o tratamento da obesidade. METODO: estudo descritivo, focado principalmente na revisão e análise de pesquisas publicadas em bases de dados científicos altamente relevantes, restringindo-se apenas a publicações a partir de 2015 (2022) que incluem o uso do Semaglutide como tema principal. RESULTADOS: 802 registros foram identificados nos bancos de dados, aplicando os critérios de seleção 45 artigos foram identificados como fontes potenciais de informação, finalmente 15 artigos foram selecionados com dados altamente relevantes para esta revisão, onde a dose do medicamento para redução de peso foi considerada, observa-se que quanto maior a quantidade de Semaglutide uma redução de peso significativa é obtida, atingindo uma média de 11,82 kg. CONCLUSAO: o tratamento semanal com Semaglutide administrado subcutaneamente com mudanças na dieta e na atividade física resulta em perda de peso sustentada clinicamente relevante ao longo do tempo, e pode ser aplicável em pacientes cujo tratamento por outros métodos mais convencionais não é eficiente.

Mechanisms of action and clinical applications of anti-obesity drugs currently available in Korea

Over the last 5 years, the Korean Ministry of Food and Drug Safety has approved four anti-obesity drugs for long-term weight management. In this review, the mechanisms of action and clinical applications of lorcaserin, naltrexone/bupropion, liraglutide, and phentermine/topiramate have been clarified. Lorcaserin stimulates proopiomelanocortin/cocaine- and amphetamine-regulated transcript neurons in the arcuate nucleus. Naltrexone/bupropion reduces body weight by controlling the hedonic reward system of food intake. The hypophagic effect of liraglutide depends on the direct activation of the proopiomelanocortin/cocaine- and amphetamine-regulated transcript neurons and indirect suppression of neuropeptide Y/agouti-related peptide neurons through gammaaminobutyric acid-dependent signaling, with an additional thermogenic effect. Phentermine/topiramate induces weight loss by elevating the norepinephrine levels in the hypothalamus, reducing energy deposition in the adipose tissue and skeletal muscle, and elevating the corticotropin-releasing hormone in the hypothalamus. In patients with high cardiovascular risks or type 2 diabetes mellitus, lorcaserin and liraglutide are appropriate. In patients with mood disorders, naltrexone/bupropion could be considered as the first choice of therapy. Notably, lorcaserin and liraglutide are neutral in the aspect of sleep disorder. In case of obese individuals with obstructive sleep apnea, liraglutide or phentermine/topiramate would be selected as the treatment option. These four drugs should be used after considering the patients' co-morbidities of obesity.

Current Treatments on Obesity

Recently, the number of obesity and diabetes mellitus have increased rapidly not only in Korea but also around the world. It is even called the new pandemic of the 21st century. In Korea, the diabetes growth rate, which exceeds the obesity growth rate, is a bigger problem. Accordingly, the simultaneous treatment of diabetes and obesity has become a global issue. In this article, we will review various obesity treatments to help diabetes remission and take a look at meaningful previous study about dietary methods for obesity. This overview includes the update of medications for obesity and the practical method for clinicians in field of obesity treatment in Korea.

Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia / Attempts to lose weight in an overweight and obese population referred to an endocrinology center in Colombia / Tentativas de perda de peso de uma população com sobrepeso e obesidade encaminhada para um centro de endocrinologia na Colômbia

Introducción. El exceso de peso es una condición prevalente en Colombia. Esto conlleva a realizar múltiples intentos para perder peso, muchos autodirigidos y con riesgos, siendo un motivo de consulta frecuente en atención médica primaria y especializada. Metodología. Estudio de corte transversal con datos secundarios de la consulta de endocrinología de pacientes que consultaron por percepción de aumento de peso. Se indagó por 18 métodos convencionales y populares para perder peso, su duración, peso perdido y posterior re ganancia. Resultados. Se incluyeron 100 personas, 79% mujeres, con un promedio de edad de 41.1 años, índice de masa corporal de 32.9 ± 4.6 kg/m2 y perímetro abdominal de 102.7 ± 12.5 cm. En promedio se registraron entre 4 y 5 intentos para perder peso por persona antes de consultar al endocrinólogo, con una mediana de historia de exceso de peso de 10 años. Todos los intentos lograron alguna pérdida con posterior reganancia del total del peso perdido, excepto liraglutida. No se encontró asociación significativa entre variables antropométricas y el número de intentos para perder peso. Discusión. Los intentos de pérdida de peso más empleados por la población evaluadas son los que no están aprobados o carecen de evidencia científica robusta. Conclusiones. Los pacientes con sobrepeso y obesidad realizan múltiples intentos fallidos para perder peso antes de consultar al médico especialista. La reganancia es muy frecuente, independientemente del tipo de intento. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introduction. Excess weight is a prevailing condition in Colombia. This leads to many weight loss attempts, many self-managed and with risks, being a frequent reason for consulting primary and specialized healthcare. Methodology. Cross-sectional study with secondary data from the endocrinology consultation of patients who made the appointment due to a perceived increase in weight. Eighteen conventional and popular ways of losing weight, their duration, the weight lost and the subsequent regained weight were investigated. Results. One hundred people were included, 79% women with an average age of 41.1 years, a body mass index of 32.9 ± 4.6 kg/m2 and a waist circumference of 102.7 ± 12.5 cm. Each person reported an average of four to five attempts to lose weight before consulting the endocrinologist, with a median history of being overweight of ten years. All of the attempts achieved some weight loss with subsequent regain of the total weight lost, except when using liraglutide. A significant association was not found between the anthropometric variables and the number of weight loss attempts. Discussion. The weight loss methods most used by the assessed population are ones that are not approved or that lack strong scientific evidence. Conclusions. Overweight or obese patients make multiple failed attempts to lose weight before consulting a specialist physician. Regain of the lost weight is frequent, regardless of the method used. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introdução. Excesso de peso é uma condição prevalecente na Colômbia. Isso leva a várias tentativas de perda de peso, muitas auto-dirigidas e de risco, sendo motivo de consultas frequentes em atendimento médico primário e especializado. Metodologia. Estudo transversal com dados secundários da consulta de endocrinología de pacientes que consultaram para percepção do ganho de peso. Foram investigados 18 métodos convencionais e populares para perder peso, sua duração, peso perdido e subsequente reganho. Resultados. Foram incluídas 100 pessoas, 79% mulheres, com idade média de 41,1 anos, índice de massa corporal de 32,9 ± 4,6 kg / m2 e perímetro abdominal de 102,7 ± 12,5 cm. Em média, foram registradas entre quatro e cinco tentativas de perda de peso por pessoa antes de consultar o endocrinologista, com uma mediana de história de excesso de peso de 10 anos. Todas as tentativas alcançaram alguma perda com subsequente re-ganancia do peso total perdido, exceto o liraglutida. Não foi encontrada associação significativa entre as variáveis antropométricas e o número de tentativas de perda de peso. Discussão. As tentativas de perda de peso mais utilizadas pela população avaliada são aquelas que não são aprovadas ou não possuem evidências científicas robustas. Conclusões. Pacientes com sobrepeso e obesos fazem várias tentativas fracassadas de perder peso antes de consultar o especialista. A re-ganancia de peso é frequente, independentemente do tipo de tentativa. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

The Use of Weight Loss Products Among Overweight and Obese Patients in Malaysia

@#Introduction: Local profiles on the use of weight loss products are scarce. The study aims to address this together with concerns on the users’ misperception of the safety of these products, and the absence of high-quality evidence to support such use. Methods: This was a cross-sectional study conducted in overweight and obese patients attending a public primary care clinic in Penang. Selected patients were given a set of self-administered questionnaire that assessed types of weight loss products used, factors that influenced the usage and the users’ perception of their own body weight and the diet products they are taking. Results: From 332 participants of this study, 18.7% were users. Mean age of users were 44.6 (SD 11.9) years. The majority (66.1%) only used dietary supplements, 11.3% used weight loss medications and the rest (22.6%) used both products. Reasons for its use were for health, a faster result to lose weight and failing dieting and exercise regimes. The average amount spent on this was RM100 per month. Commonest source of weight loss products were friends. Majority (80.6%) did not discuss the use of the products with doctors. Factors associated with the use of weight loss products were being female (AOR=5.59), had tertiary level education (AOR=2.27), being employed (AOR=3.42), self-perceived of overweight (AOR=3.61) and perception that weight loss products as safe (AOR 2.48). Conclusion: Users of weight loss products are among highly educated working females who perceived themselves as being overweight and assume the products are safe

Recent Advances in Anti-Obesity Agents / 대한내과학회지

Obesity is a chronic disorder that is a significant risk factor for diabetes, cardiovascular diseases, malignancy, and other chronic diseases. Lifestyle modifications form the basis of most treatments for obesity, but it has become clear that such modifications alone are not enough for many obese patients. When a behavioral approach is insufficient, pharmacological treatment may be recommended. In recent years, the US Food and Drug Administration (FDA) has withdrawn several therapeutic options for obesity due to their side effects, but has approved four novel anti-obesity agents. Until recently, orlistat was the only drug approved for the management of long-term obesity, but the US FDA approved the novel anti-obesity drugs lorcaserin and phentermine/topiramate in 2012, and naltrexone/bupropion and liraglutide in 2014. The present review discusses the different pharmacotherapeutic options for the treatment of obesity.

Study of clinical intervention of Shanzha Xiaozhi capsule on obesity patients with dampness-heat constitution / 天津医药

Objective To investigate the effects of Shanzha Xiaozhi capsule on body weight, metabolic index, percentage and distribution of body fat in obese patients with dampness-heat constitution. Methods A total of 60 obesity patients with dampness-heat constitution were enrolled in this study and randomly categorized into the control group ( n=30) and treatment group (n=30). Control group was given the diet and exercise regime, and treatment group was given Shanzha Xiaozhi capsule based on the same diet and exercise regime for 12 weeks. Scores of dampness-heat, body weight, waist circumference, hip circumference, blood pressure, blood glucose, serum lipid profile, urine acid (UA), fasting plasma insulin, serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, adiponectin, lipopolysaccharide (LPS), percentage and distribution of body fat were measured before and after treatment. Results (1) Data of scores of dampness-heat and diastolic blood pressure were significantly decreased after treatment in drug group. The above indexes and hip circumference were significantly decreased after the treatment in treatment group compared with those of control group ( P<0.05). (2) The triglyceride (TG), UA, insulin, HOMA-IR, LPS and IL-1βwere significantly decreased after the treatment in treatment group than those of control group, while there were no significant differences in fast blood glucose (FBG), 2 h postprandial plasma glucose (2 hPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), TNF-α, IL-6 and adiponectin between two groups. (3) The percentage of visceral fat was significantly decreased in treatment group than that of control group. There were no significant differences in fat changes of limbs and buttocks between two groups. Conclusion Shanzha Xiaozhi capsule can decrease body weight and visceral fat content, reduce insulin resistance, and improve chronic inflammation state in obese patients with dampness- heat constitution.

Safety and efficacy of fenproporex for obesity treatment: a systematic review / Segurança e eficácia do fenproporex para tratamento da obesidade: revisão sistemática

ABSTRACT OBJECTIVE To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. METHODS MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to treat obesity. RESULTS Only four controlled studies met the inclusion criteria. One randomized, placebo-controlled trial on Fenproporex was found on electronic databases. Three placebo-controlled studies (in non-indexed journals) were identified by hand-searching. Patients with cardiovascular and other comorbidities were excluded in all studies. Trials lasted from 40 to 364 days and doses ranged from 20 to 33.6 mg/d. All controlled studies found that weight loss among Fenproporex-treated patients was greater than that produced by the placebo, but drug effect was modest. Fenproporex produced additional weight reductions of 4.7 kg (one year), 3.8 kg (six months) and 1.55 kg (two months) in average, in relation to diet and exercise only (three trials). Insomnia, irritability, and anxiety were the most frequently reported side effects in the four studies. CONCLUSIONS There is a paucity of randomized, placebo-controlled trials on Fenproporex and those identified here present major methodological flaws. These studies suggest that Fenproporex is modestly effective in promoting weight loss. Nonetheless, they failed to provide evidence that it reduces obesity-associated morbidity and mortality. Data from these studies are insufficient to determine the risk-benefit profile of Fenproporex. Abuse potential and amphetamine-like adverse effects are causes for concern.

RESUMO OBJETIVO Avaliar a evidência clínica de segurança e eficácia do Fenproporex para tratamento da obesidade. MÉTODOS Pesquisamos publicações em qualquer idioma nas bases Medline, Lilacs Cochrane Controlled Trials Register e também referências citadas por artigos e documentos relevantes. Dois autores avaliaram independentemente os estudos para inclusão e quanto ao risco de viés, dados coletados e precisão. Foram elegíveis estudos controlados com placebo que forneceram dados sobre a eficácia e segurança do Fenproporex para tratar a obesidade. RESULTADOS Apenas quatro estudos controlados preencheram critérios de inclusão. Um estudo placebo-controlado aleatorizado do Fenproporex foi encontrado nas bases eletrônicas. Três estudos controlados (em periódicos não indexados) foram identificados por buscas manuais. Pacientes com comorbidades (cardiovasculares ou outras) foram excluídos em todos os estudos. A duração dos estudos foi de 40 a 364 dias, com doses de 20 a 33,6 mg/d. Todos os estudos controlados encontraram maior perda de peso entre pacientes tratados com Fenproporex, comparados aos que receberam placebo, mas o efeito foi modesto. O Fenproporex causou reduções adicionais de peso de 4,7 kg (após um ano), 3,8 kg (após seis meses) e 1,55 kg (após dois meses), em média, em relação à dieta e exercício apenas (três ensaios). Insônia, irritabilidade e ansiedade foram os eventos colaterais mais frequentes nos quatro estudos. CONCLUSÕES Ensaios clínicos placebo-controlado aleatorizado do Fenproporex são escassos e os estudos controlados identificados apresentam importantes falhas metodológicas. Esses estudos sugerem que o Fenproporex é modestamente eficaz em promover perda de peso. Entretanto, eles não fornecem evidências de que o Fenproporex atenua a morbidade e mortalidade associada à obesidade. Esses estudos são insuficientes para avaliar o perfil risco-benefício do Fenproporex. Potencial de abuso e efeitos adversos do tipo anfetamínico são motivos de preocupação.

New Drugs for Obesity Treatment / 대한내과학회지

There have recently been many advances in obesity treatment, including lifestyle modifications and pharmacological and surgical treatments. Specifically, pharmacological strategies have improved significantly. However, the history of the development of medications aimed at weight loss is complicated. The Federal Drug Administration (FDA) withdrew anti-obesity drugs such as fenfluramine, dexfenfluramine, and phenylpropylamine due to their unwanted side effects. Moreover, sibutramine was voluntarily withdrawn from the market and a new drug, rimonabant, has been suspended in the middle of a clinical trial due to unacceptable side effects. The FDA has approved four new anti-obesity drugs in recent years. Lorcaserin is a selective 5-hydroxytryptamine receptor 2c (5-HT2c) agonist. The pharmacological mechanism of action of this drug is similar to fenfluramine and dexfenfluramine, but lorcaserin is specific for 5-HT2c, which are located almost exclusively in the central nervous system and are not found in heart valves. Three phase 3 clinical trials for lorcaserin have been published recently; weight reduction was successful and no side effects involving the heart were found. Furthermore, the FDA has also approved phentermine/topiramate controlled-release (PHEN/TPM CR), which is composed of a combination of immediate-release phentermine and controlled-release topiramate. Weight reduction achieved with PHEN/TPM CR was demonstrated to be better than all other anti-obesity drugs. Lastly, the combination therapy bupropion/naltrexone activates proopiomelanocortin neurons and inhibits opioid-mediated negative feedback by synergism. Similar to liraglutide, a long-acting analogue of the hormone glucagon-like peptide-1, this treatment showed significant weight loss and metabolic improvements. However, in addition to its efficacy, clinicians should consider its side effects before use.

Recent Advances for Anti-Obesity Agents / 임상당뇨병

Obesity is one of the most significant risk factor for diabetes, cardiovascular disease, malignancy and other chronic diseases. The obesity and its associated conditions is one of the most urgent health concerns worldwide. Lifestyle modifications comprising diet modification, exercise, and behavior therapy are basic to the treatment for obesity. However, it has become apparent that lifestyle modifications alone will not be enough for many patients with obesity. Therefore, apractical approach includes consideration of pharmacotherapeutic options. Until 2012, orlistat was the only approved medication for long-term obesity management. In 2012, lorcaserin and phentermine/topiramate were approved by the USA Food and Drug Administration as new anti-obesity drugs, and in 2014, two additional medications were added, naltrexone/bupropion and liraglutide. This review discusses the different pharmacotherapeutic options for the treatment of obesity.

Pharmacotherapy for Obesity

Obesity is an important risk factor for metabolic disease and various cancers. Treatments of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. If weight loss with lifestyle intervention is only modest, pharmacotherapy might be needed. Pharmacotherapy agents can be grouped by treatment period as short term or long term use agent. Several sympathomimetic drugs such as benzphetamine, diethylpropion, phendimetrazine and phentermine, are approved for short term treatment due to their safety issues. For long term treatment, orlistat, lorcaserin, and combination of phentermine/topiramate are approved by U.S. Food and Drug Administration (FDA). Orlistat partially blocks intestinal digestion of fat, therefore producing weight loss. Lorcaserin is a serotonin 2C receptor agonist. The combination of phentermine/topiramate produces a mean weight loss of 8-10 kg. Side effects of each drug are quite different. For obesity patient, side effects are important factor when choosing drugs. The goal of this article is to review currently available anti-obesity drugs.

Tratamento de curto prazo com liraglutide no reganho de peso após cirurgia bariátrica / Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery

OBJETIVO: avaliar os resultados da utilização do liraglutide em um grupo de pacientes submetidos ao tratamento cirúrgico da obesidade mórbida com perda insatisfatória de peso ou ganho de mais de 15% do seu peso mínimo atingido. MÉTODOS: realizou-se análise retrospectiva de 15 pacientes operados que tiveram perda de excesso de peso <50% após dois anos de seguimento ou reganho de peso de mais de 15% do peso mínimo atingido. Foram incluídos apenas pacientes que apresentavam a "anatomia cirúrgica" normal avaliada por radiografia contrastada e endoscopia digestiva alta. A média de idade foi 47,2±12,5 anos e os pacientes receberam liraglutide na dose de 1,2 a 3,0mg/dia por oito a 28 semanas de seguimento. RESULTADOS: o tratamento cirúrgico induziu uma perda de peso de 34,1± 16,5Kg. A média de reganho de peso após 5,3 ±3,3 anos foi 14,2±12,1Kg. A media de peso reduziu significativamente após o tratamento com liraglutide (100,9±18,3Kg vs. 93,5±17,4Kg; p<0,0001). Seis pacientes apresentaram náuseas e dois descontinuaram o tratamento em decorrência do custo da medicação. CONCLUSÃO: o tratamento clínico medicamentoso dirigido para o controle da saciedade com o uso do liraglutide pode ser uma alternativa para manejo dos pacientes com reganho de peso ou perda insuficiente após o tratamento cirúrgico, quando nenhum problema técnico tenha sido identificado.

OBJECTIVE: To evaluate the results of the use of liraglutide in a group of patients undergoing surgical treatment of morbid obesity with unsatisfactory weight loss or regain of more than 15% of minimum reached weight. METHODS: The authors conducted a retrospective analysis of 15 operated patients who had excess weight loss <50% after two years of follow-up or regained weight more than 15% of the minimum reached weight. We included only patients who had the expected "surgical anatomy", assessed by contrast radiography and endoscopy. Mean age was 47.2 ± 12.5 years, and patients received liraglutide at doses from 1.2 to 3.0 mg/day for eight to 28 weeks follow-up. RESULTS: Surgical treatment induced a weight loss of 34.1 ± 16.5 kg. The average weight regain after 5.3 ± 3.3 years was 14.2 ± 12.1 Kg. The average weight was significantly reduced after treatment with liraglutide (100.9 ± 18.3 kg. vs Kg 93.5 ± 17.4, p <0.0001). Six patients had nausea and two discontinued therapy due to the cost of medication. CONCLUSION: medical treatment directed to the control of satiety using liraglutide may be an alternative treatment of patients with poor weight loss or weight regain after surgery when no technical problem has been identified.

Weight Loss Drugs Recently Approved by the FDA / 임상당뇨병

There have been many advances in obesity treatment, including life-style modification and pharmacological and surgical treatments. It seems that the most remarkable advances in obesity treatment are those of pharmacological strategies. However, weight loss medications have a long history of development. The FDA has withdrawn anti-obesity drugs such as fenfluramine, dexfenfluramine, and phenylpropylamine due to unwanted side effects. Sibutramine was voluntarily withdrawn from the market, and new drugs such as rimonabant have been suspended in the middle of clinical study due to unacceptable side effects. Last year, the FDA approved two new anti-obesity drugs for the treatment of obesity. Lorcaserin is a selective 5-hydroxytryptamine receptor 2c (5-HT2c) agonist whose pharmacological mechanism of action is similar to those of fenfluramine and dexfenfluramine. However, lorcaserin is specific for 5-HT2c, which is located almost exclusively in the CNS and is not found on heart valves. Three exciting phase 3 clinical trials for lorcaserin have been published recently. Lorcaserin has been shown to successfully result in weight reduction, and the drug was not found to lead to heart disease, as is the case with some other such drugs. Furthermore, the FDA also approved controlled release phentermine/topiramate (PHEN/TPM CR), a drug composed of immediate-release phentermine and controlled-release topiramate. Weight reduction by PHEN/TPM CR is better than any other anti-obesity drugs in the world. Along with this excellent efficacy, however, come painful side effects that clinicians should consider.

A Case of Dilated Cardiomyopathy with Massive Left Ventricular Thrombus after Use of a Sibutramine-Containing Slimming Product

Sibutramine, which acts as an anti-obesity drug by inhibiting reuptake of serotonin and norepinephrine, has now been banned due to cardiovascular adverse effects. However, despite being banned, it is not uncommon for people to purchase products with sibutramine or its analogues used as adulterants in non-prescription slimming products or health foods available on the internet. Sibutramine has been associated with rare but serious adverse reactions such as cardiac arrhythmia including QT interval prolongation, myocardial infarction, and cardiomyopathy, as well as increases in blood pressure and pulse rate. Here, we report a case of a 32-year-old male who presented with dilated cardiomyopathy with massive left ventricular thrombus after taking unauthorized sibutramine-containing slimming pills sold over the internet.

Phentermine, Sibutramine and Affective Disorders

A safe and effective way to control weight in patients with affective disorders is needed, and phentermine is a possible candidate. We performed a PubMed search of articles pertaining to phentermine, sibutramine, and affective disorders. We compared the studies of phentermine with those of sibutramine. The search yielded a small number of reports. Reports concerning phentermine and affective disorders reported that i) its potency in the central nervous system may be comparatively low, and ii) it may induce depression in some patients. We were unable to find more studies on the subject; thus, it is unclear presently whether phentermine use is safe in affective disorder patients. Reports regarding the association of sibutramine and affective disorders were slightly more abundant. A recent study that suggested that sibutramine may have deleterious effects in patients with a psychiatric history may provide a clue for future phentermine research. Three explanations are possible concerning the association between phentermine and affective disorders: i) phentermine, like sibutramine, may have a depression-inducing effect that affects a specific subgroup of patients, ii) phentermine may have a dose-dependent depression-inducing effect, or iii) phentermine may simply not be associated with depression. Large-scale studies with affective disorder patients focusing on these questions are needed to clarify this matter before investigation of its efficacy may be carried out and it can be used in patients with affective disorders.

Prevalence of weight-loss strategies and use of substances for weight-loss among adults: a population study / Prevalência de estratégias de emagrecimento e uso de substâncias para perder peso entre adultos: um estudo populacional

This paper concerns a cross-sectional population-based study conducted with adults living in the city of Pelotas, Rio Grande do Sul State, Brazil. It aims to determine the prevalence of weight-loss practices and use of substances for weight-loss during the 12 months preceding the interview. The prevalence of weight-loss attempts was 26.6%. Although dietary control and regular physical exercise were the most commonly used strategies, the prevalence of the combined use of these methods was only 36% for individuals trying to lose weight. The prevalence of use of substances for weight-loss was 12.8% (48.4% of those who tried to lose weight). The use of dietary control and substances was more common among women, while men practiced physical exercise with greater frequency. Teas were the most frequently used substances for weight-loss. Multivariate analysis identified being female, excess weight and self-perception of excess weight as major associated factors for the use of substances for weight-loss. Finally, we found that, although weight-loss attempts are common, the majority of obese individuals do not make attempts to lose weight and only a minority follows the recommended practices.

Estudo transversal de base populacional conduzido com adultos residentes na cidade de Pelotas, Rio Grande do Sul, Brasil, que objetivou determinar a prevalência de práticas de emagrecimento e uso de substâncias para emagrecer, nos últimos 12 meses antes da entrevista. A prevalência de tentativas de emagrecimento foi de 26,6%. Controle dietético e prática regular de exercícios físicos foram as estratégias mais frequentes, mas apenas 36% daqueles que tentaram emagrecer combinaram-nas. A prevalência do uso de substâncias para emagrecer foi de 12,8% (48,4% daqueles que tentaram emagrecer). Mulheres utilizaram controle dietético e substâncias mais frequentemente do que homens, enquanto estes utilizaram mais exercícios físicos. As substâncias de uso mais frequente foram os chás. A análise ajustada identificou sexo feminino, excesso de peso e percepção do excesso de peso como os maiores fatores associados ao uso de substâncias. Assim, identificamos que tentativas de emagrecimento são frequentes, porém, não são referidas pela maioria dos obesos e apenas uma minoria daqueles que tentam emagrecer segue as práticas recomendadas.

Anti-Obesity Drugs: A Review about Their Effects and Safety

The current recommendations for the treatment of obese people include increased physical activity and reduced calories intake. When the behavioral approach is not sufficient, a pharmacologic treatment is recommended. In past years, numerous drugs have been approved for the treatment of obesity; however, most of them have been withdrawn from the market because of their adverse effects. In fact, amphetamine, rimonabant and sibutramine licenses have been withdrawn due to an increased risk of psychiatric disorders and non-fatal myocardial infarction or stroke. Even if orlistat is not as effective as other drugs in reducing body weight, orlistat is presently the only available choice for the treatment of obesity because of its safety for cardiovascular events and positive effects on diabetic control. Hopefully, more effective and better tolerated anti-obesity drugs will be developed through an improved understanding of the multiple mechanisms and complex physiological systems targeting appetite.

Recent Advances in Obesity Research and Management / 한양의대학술지

Obesity is at epidemic proportions worldwide. Obesity is a significant risk factor for cardiovascular disease, diabetes, cancer and other chronic diseases. Initial lifestyle modification may be intended to induce 7-10% decrease in baseline body weight in obese subjects. Drug therapy can be introduced for subjects with a BMI> or =30 kg/m2 or in those with a BMI > or =27 kg/m2 when comorbidities, such as hypertension or type 2 diabetes mellitus, are present. Bariatric surgery is widely available and can be performed for individuals with a BMI > or =40 kg/m2 (or for patients with a BMI> or =35 kg/m2 and comorbidities) who are unsuccessful with other therapies. Recently, many basic research findings showed that inflammatory responses to metabolic dysfunctions are key pathophysiologic changes in obesity and insulin resistance. Further studies will be required to find out effective targets to manage obesity and to resolve various unanswered issues about diet and exercise regimens. Furthermore, more data about bariatric surgeries are required.

Long-term health benefits of appetite suppressants remain unproven / Benefícios dos inibidores de apetite à saúde a longo prazo permanecem sem comprovação / Beneficios de los inhibidores de apetito en la salud a largo plazo permanecen sin comprobación

Because of the increasing prevalence of obesity, prevention and treatment of overweight has become a major public health concern. In addition to diet and exercise, drugs are needed for patients who failed to lose weight with behavioral treatment. The current article aimed to summarize recent concerns on the safety and efficacy of appetite suppressants. Several appetite suppressants have been banned for safety reasons. In 2010, sibutramine was withdrawn from the market because a long-term study showed it increased the risks of cardiovascular events. So far no study with a sufficiently large sample size has demonstrated that appetite suppressants can reduce morbidity and mortality associated with overweight. The withdrawal of sibutramine highlights that guidelines for the evaluation of weight control drugs must be more stringent, and studies on their long-term health benefits are needed prior to their marketing.

O aumento da prevalência da obesidade tornou a prevenção e tratamento do sobrepeso importante desafio para a Saúde Pública. Além da dieta e exercício, os medicamentos são necessários para pacientes que não conseguem perder peso com as mudanças comportamentais. O objetivo do artigo foi sumarizar as preocupações atuais com a segurança e efetividade de medicamentos inibidores do apetite. Vários anorexígenos foram banidos por razões de segurança. Em 2010, a sibutramina foi retirada do mercado porque um estudo de longa duração mostrou que ela aumentava o risco de eventos cardiovasculares. Até agora nenhum estudo com número expressivo de pacientes demonstrou que anorexígenos reduzem a morbi-mortalidade associada ao sobrepeso. A retirada da sibutramina do mercado mostra que diretrizes para avaliação de medicamentos anorexígenos devem ser mais rigorosas, e que estudos de longa duração sobre os benefícios para a saúde devem ser realizados antes da comercialização.

El aumento de la prevalencia de la obesidad ha convertido la prevención y tratamiento del sobrepeso importante desafío para la Salud Pública. Aunado a la dieta y ejercicio, los medicamentos son necesarios para pacientes que no logran perder peso con los cambios de comportamiento. El objetivo del artículo fue englobar las preocupaciones actuales con la seguridad y la efectividad de medicamentos inhibidores del apetito. Varios anorexígenos fueron eliminados por razones de seguridad. En 2010, la sibutramina fue retirada del mercado porque un estudio de larga duración demostró que ésta aumentaba el riesgo de eventos cardiovasculares. Hasta ahora ningún estudio con número considerable de pacientes demostró que anorexígenos reducen la morbi-mortalidad asociada al sobrepeso. La retirada de sibutramina del mercado muestra que directrices para evaluación de medicamentos anorexígenos deben ser más rigurosas, y que estudios de larga duración sobre los beneficios para la salud deben ser realizados antes de la comercialización.

Uso de drogas antiobesidade entre estudantes universitários / Use of anti-obesity drugs among college students

OBJETIVO: Avaliar o uso de drogas antiobesidade entre estudantes de uma universidade pública. MÉTODOS: Estudo transversal com amostra probabilística constituída por 664 universitários. Foram observadas variáveis socioeconômicas, antropométricas e uso das drogas. O índice de massa corpórea (IMC) e circunferência da cintura (CC) foram classificados segundo critérios da Organização Mundial de Saúde. RESULTADOS: Uso atual ou anterior de agentes antiobesidade foi referido por 6,8 por cento dos estudantes. As anfetaminas e as aminas simpaticomiméticas (40,5 por cento) foram as drogas mais usadas. Entre aqueles que referiram uso de agentes antiobesidade, 62,2 por cento eram do sexo feminino. Apenas 31,1 por cento das prescrições foram indicadas por médicos. As médias de IMC e CC foram maiores entre estudantes que referiram uso de tais drogas, mas 47 por cento deles foram classificados como eutróficos pelo IMC, e 76,5 por cento apresentavam medida de CC normal. CONCLUSÃO: O uso de drogas antiobesidade se mostrou preocupante, principalmente pela elevada proporção de uso sem indicação ou prescrição médica.

OBJECTIVE: To evaluate the use of anti-obesity drugs among students attending a public university. METHODS: This was a cross sectional random study of 664 college students. Drug use, socioeconomic, and anthropometric variables were observed. Body mass index (BMI) and waist circumference (WC) were classified according to World Health Organization criteria. RESULTS: Current or previous use of anti-obesity drugs was reported by 6.8 percent of students. Amphetamine and sympathomimetic amines (40.5 percent) were the most commonly used drugs. Among those who reported use of anti-obesity agents, 62.2 percent were female. Only 31.1 percent of medications were prescribed by doctors. Mean BMI and WC were higher among students reporting the use of such drugs, but 47 percent of them were classified as eutrophic by BMI, and 76.5 percent had normal WC measure. CONCLUSION: The use of anti-obesity drugs among college students is of concern, particularly due to the high proportion of drug use without indication or prescription.