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What are the treatment options for obesity?
Obesity is associated with increased morbidity (i.e., diabetes mellitus, dyslipidemia, hypertension, sleep apnea, coronary artery disease) and mortality. Weight loss (i.e., 5%-10% loss) can modify metabolic parameters and reduce the risks associated with obesity. Lifestyle modification (i.e., diet and exercise) is the cornerstone of treatment. For individuals who fail lifestyle measures, pharmacologic and surgical therapy can be considered.
Pharmacologic Therapy for Obesity
| Drug | Mechanism of action | Side Effect |
|---|---|---|
| Orlistat | Reduces fat absorption by inhibiting pancreatic lipase | Cramps, flatulence, fecal incontinence, reduced absorption of fat-soluble vitamins, liver injury, calcium oxalate stones |
| Lorcaserin | Stimulates serotonin receptor 2C, which reduces appetite | Headache, nasopharyngitis, nausea Contraindicated: liver disease, renal failure, use with other serotoninergic agents |
| Sympathomimetic drugs (i.e., phentermine, diethylpropion, benzphetamine, phendimetrazine) | Stimulates norepinephrine release or prevents reuptake of norepinephrine into the nerve terminal, which causes early satiety | Increased heart rate, increased blood pressure, insomnia, dry mouth, constipation, nervousness, potential for abuse (duration of use limited to 12 weeks only) |
| Topiramate | Antiepileptic drug | Paresthesia, somnolence, metabolic acidosis |
Medications available for the treatment of obesity?
Pharmacologic therapy can be offered to individuals with BMI greater than 30 kg/m 2 or BMI greater than 27 kg/m 2 and comorbid conditions (e.g., diabetes, dyslipidemia, hypertension). Weight loss of 4 to 6 kg is noted with most agents. Orlistat is typically the first-line choice, followed by lorcaserin. For obese patients with diabetes, antidiabetic agents associated with weight loss can be considered.
