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Drug Treatments for Obesity

As successful as bariatric surgery?…

It is well known that obesity remains a leading cause of mortality and type 2 diabetes throughout the world, despite its ability to be prevented through life-style changes, drug treatments, and bariatric surgery. Current literature suggests that pharmacological treatments show only modest benefits for the treatment of obesity as compared to invasive bariatric surgical procedures.

A recent publication reviewed the evidence to determine whether pharmacological intervention could yield same weight loss efficacy via bariatric surgery in obese patients. Recently approved combination medications to treat obesity were discussed.

Qsymia, a combination of phentermine and topiramate, has been recently approved as a treatment for obesity and is used in type 2 diabetes. The phentermine acts to suppress appetite, while the anticonvulsant topiramate adds the desired side effect of weight loss. Similarly, the drug Contrave combines bupropion and naltrexone in order to inhibit reuptake of dopamine and norepinephrine and harness a synergistic weight loss benefit. Lorcaserin (Belviq) is another anti-obesity drug that has shown promise as a 5-HT2C receptor agonist to increase satiety and weight loss.

Intestinal gut hormones are also discussed as both existing and potential drug targets. Amylin, Ghrelin, Peptide tyrosine-tyrosine (PYY), Pancreatic polypeptide (PP), Oxyntomodulin (OXM), and Cholecystokinin (CCK) are mentioned as peripheral drug targets for obesity treatments.

The authors conclude that combinations of pharmacological agents may be required to achieve the weight loss efficacy seen with bariatric surgery. Indeed, clinical trials of drugs in development show many of these combinations in the pipeline with improved weight loss profiles as compared to their single-agent counterparts. In the future we may see more combinations of gut hormones utilized as drug targets for obesity drugs.

Practice Pearls:

  • Obesity remains a leading cause of mortality and type 2 diabetes throughout the world, despite its ability to be prevented.
  • Peripheral targets for obesity treatments include multiple gut hormones including PYY, PP, OXM, and CCK.
  • Combinations of pharmacological agents may be required to achieve the weight loss efficacy seen with bariatric surgery.

Diabetes/Metabolism Research & Reviews 2013; Davenport, R.J. Treating Obesity: Is it all in the gut? Drug Discovery Today (2013)]