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Cardio Diabetes Medicine 2017 443

Obesity- Pharmacotherapy

Dr. Rakesh Kumar Sahay, MD, DM (Endo), FACE, FICP, FRSSDI
Professor & Head of Department of Endocrinology, Osmania Medical College, Hyderabad
Dr. Shravan Ankathi, MD (Medicine)
Department of Endocrinology, Osmania Medical College, Hyderabad

Abstract can reduce life expectancy [1]. Worldwide obesity has
Recent advances in the understanding of energy more than doubled since 1980.In 2014, more than 1.9
balance control have draw special attention to a billion adults, 18 years and older, were overweight.
number of new biological targets for the treatment of Of these over 600 million were obese.39% of adults
obesity. Some of these pharmacological approaches aged 18 years and over were overweight in 2014, and
for weight loss have yielded promising results in 13% were obese [2]. Most of the world’s population
clinical trials. Lorcaserin, Phentermine-topiramate live in countries where overweight and obesity kills
combination (phen-top), Liraglutide Bupropion- more people than underweight.
Naltrexone and Orlistat are the currently approved Pathophysiology of obesity is complex, and new
drugs by US FDA. Lorcaserin, a 5HT 2C agonist has information regarding neuronal circuits that control
moderate efficacy with an acceptable safety profile, food intake and their hormonal regulation has
Phenteramine blocks of norepinephrine reuptake, enlarged our understanding of energy homoeostasis
Phen-top combination in clinical trials have shown a [3]. These new signaling pathways discovered in the
reasonable efficacy but at the risks of teratogenicity hypothalamus are potential targets for development
and psychiatric disturbances. in the

Liraglutide, a glucagon-like peptide 1 (GLP-1) analog treatment of obesity. Some pharmacotherapies have
has a good efficact with relatively few side effects ultimately failed due to unexpected side effects that
compared with centrally acting drugs. Bupropion- may only identify during clinical trials and sometimes
naltrexone act on the monoaminergic and opioid many years following drug approval. Yet despite many
systems previous setbacks in the obesity drug development
process, several clinical trials in the last two decades
However, finding the precise balance between
efficacy and safety has proven challenging. In this lead to develop new, safer and more tolerable anti-
article, we provide an overview of currently available obesity medications. In the last 10 years, several
anti-obesity agents, and discuss future strategies for therapies have emerged as potentially effective and
pharmacological interventions. Given the high unmet safe new long-term weight-loss pharmacotherapies.
need and our growing understanding pathophysiology
of bodyweight homeostasis, novel, more efficacious Diagnosis and Classifcation of Obesity
and better tolerated treatments for obesity are clearly The diagnosis and classification of obesity is usually
required. based on the BMI. This simple anthropometric index
can be calculated from body weight and height,
Introduction is independent of body height and correlates
Obesity is defined as a common chronic disorder reasonably well with body fat mass (r = 0.4–0.7). The
of excessive body fat and has become a global current classification of body weight is according to
epidemic, which is present not only in the the World Health Organization (WHO) [3]
industrialized world but also in many developing and BMI should be used to confirm an excessive degree
even in underdeveloped countries. Obesity impairs of adiposity and to classify individuals as having
the subjective quality of life in affected people and overweight (BMI 25-29.9 kg/m ) or obesity (BMI
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