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Current pharmacotherapy for obesity

Key Points

  • Obesity is a chronic, debilitating disease with devastating overall health effects and a global burden of disease; weight loss can improve these outcomes

  • Anti-obesity drugs should be initiated promptly when appropriate criteria are met if a patient fails self-directed or professionally directed lifestyle treatment

  • Anti-obesity drugs are approved in patients with a BMI ≥27 kg/m2 with at least one obesity-related comorbidity such as diabetes mellitus, hypertension, hyperlipidaemia or sleep apnoea or in patients with a BMI ≥30 kg/m2

  • Currently, six major FDA-approved anti-obesity medications are available: phentermine, orlistat, phentermine/topiramate extended release (ER), lorcaserin, naltrexone sustained release (SR)/bupropion SR and liraglutide (the only injectable formulation)

  • Most of these anti-obesity drugs have an efficacy of 3–7% (estimated net weight loss)

  • Identifying the type of obesity on clinical presentation coupled with an understanding of anti-obesity drug safety, contraindications and adverse effect profiles can selectively increase weight loss through appropriate use of these drugs

Abstract

More than one-third of adults in the USA have obesity, which causes, exacerbates or adversely impacts numerous medical comorbidities, including diabetes mellitus and cardiovascular disease. Despite intensive lifestyle modifications, the disease severity warrants further aggressive intervention, including pharmacotherapy, medical devices and bariatric surgery. Noninvasive anti-obesity drugs have thus now resurfaced as targeted adjunctive therapeutic approaches to intensive lifestyle intervention, bridging the gap between lifestyle and bariatric surgery. In this Review, we discuss FDA-approved anti-obesity drugs in terms of safety and efficacy. As most of these drugs have a mean percentage weight loss reported in clinical trials but individual variations in response rates, a future direction of obesity pharmacotherapy research might include the potential for personalized medicine to target early responders to these anti-obesity drugs.

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Figure 1: Neuronal and hormonal pathways influencing food intake and satiety in the brain.
Figure 2: Efficacy of anti-obesity drugs.

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Acknowledgements

The authors thank A. McCarthy for editorial and administrative assistance.

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G.S. and C.M.A. researched data for the article, made substantial contributions to discussions of the content, wrote the article and reviewed and/or edited the article before submission.

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Correspondence to Caroline M. Apovian.

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G.S. declares no competing interests. C.M.A. has received personal fees from Gelesis, GI Dynamics, Johnson and Johnson, Merck, NovoNordisk, Nutrisystem, Orexigen, Sanofi-Aventis, Scientific Intake, Takeda and Zafgen; grants from Aspire Bariatrics, the Robert C. and Veronica Atkins Foundation, Coherence Lab, Energesis, Gelesis, GI Dynamics, Myos, Orexigen, PCORI, Takeda and Vela Foundation; and other forms of support from Science-Smart. No grant support or external funding was provided to G.S. or C.M.A. for the drafting of this manuscript.

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Srivastava, G., Apovian, C. Current pharmacotherapy for obesity. Nat Rev Endocrinol 14, 12–24 (2018). https://doi.org/10.1038/nrendo.2017.122

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