Behavioral Intervention and Anti-Obesity Drug Therapy / 대한내과학회지

Obesity is associated with a reduction in life expectancy and an increase in mortality from cardiovascular diseases, cancer, and other causes. The U.S. Preventive Service Task Force (USPSTF) recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. Behavioral interventions can lead to a moderate weight loss and improvement in blood sugar and other risk factors for cardiovascular disease. Behavioral interventions decreased the incidence of diabetes diagnosis by about 50% over 2 to 3 years. Orlistat, phentermine, diethylpropion, phendimetrazine, mazindol have been approved as anti-obesity drugs by Korea Food and Drug Administration. The U.S. Food and Drug Administration approved lorcaserin and phentermine plus topiramate combination for treatment of obesity in 2012.

Lorcaserin: a selective serotonin receptor (5-HT2C) agonist for the treatment of obesity.

Lorcaserin is a selective serotonin receptor (5-HT2C) agonist that recently received the U.S. Food and Drug Administration (FDA) approval for chronic weight management. The efficacy of this drug in reducing body weight and improving metabolic parameters of obese patients has been demonstrated in three phase-3 clinical trials. The available evidence indicates that this drug does not show heart valve abnormalities, and the treatment improves the risk factors for type 2 diabetes and cardiovascular diseases. However, the drug’s manufacturer will be required to conduct postmarketing studies, including a long-term cardiovascular outcomes trial to assess the effect of Lorcaserin on the risk for major adverse cardiac events such as heart attack and stroke.

Clinical Guidelines of Treatment of Obesity in Adults

Obesity increases the risk of serious medical conditions such as type 2 diabetes and coronary heart disease. The risks associated with comorbidities can be reduced with a modest weight loss. Obesity should be recognized and treated as a chronic, progressive, and relapsing disease. The management of obesity requires a long-term approach that is tailored to an individual's lifestyle and needs. Initial treatment should focus on lifestyle changes, i.e., reduced calorie intake and increased physical activity, with behavior modification strategies. Medications may be used adjunctively. Most of FDA-approved anti-obesity drugs should be prescribed for short-term weight loss. Recently, sibutramine and orlistat were approved for long-term weight loss and maintenance. In addition to weight reduction, sibutramine and orlistat provided beneficial effects on cardiovascular risk factors in clinical trials. Several drugs, such as fluoxetine, bupropion and topiramate, approved for other uses, have shown weight loss in some clinical trials. Surgical treatment should be reserved for severely obese patients with significant medical comorbidities or physical conditions.