Obesity is a growing concern for public health authorities worldwide. While no country in the world is exempted from the burden of overweight and obesity, the most affected countries are the US, Mexico, Canada, and some European and Arab countries – all of them with over 25% of their population exhibiting this problem. A person is considered obese when their body mass index exceeds 30 kg/m2, which increases the likelihood of suffering from chronic and degenerative diseases such as diabetes type 2, hypertension, cardiovascular diseases, osteoarthritis, and certain types of cancer. This ultimately leads to reduced life expectancy. In average, obese people live five to seven years less than persons with a body mass index between 22 and 25 kg/m2.
Among the many approaches to losing weight, pharmacotherapy has shown significant advances in recent years with multinational companies investing millions of dollars in the development of safer and effective drugs. Scientifically proven methods will become more relevant and frequent as regulatory agencies around the world manage to phase out miracle products and dangerous interventions. Just in 2015, COFEPRIS confiscated 2.15 million units of miracle products, including herbal extracts, infusions, and supplements with illegal weight loss claims.
The first wave of anti-obesity medicines included drugs such as Orlistat, Sibutramine, phentermin, diethylpropion, mazindol, and fenproporex. Orlistat blocks the absorption of fat thereby reducing calorie intake. Sibutramine is an oral appetite suppressant that is prohibited in a number of countries including the US, Mexico, and the EU for its side effects. Phentermin, diethylpropion, and mazindol act on brain centers associated with appetite in a similar way to amphetamines. Fenproporex is a stimulant drug that has never been approved in the US, and on the contrary has been detected as an unlabeled component of diet pills on the internet. These drugs were developed in the 1960s and their use is now almost abandoned.
The second generation of anti-obesity drugs include drugs such as phentermine/topiramate, lorcaserin, naltrexone, and liraglutide. The combination of phentermine/topiramate has been proven to reduce weight in 10% in combination with diet and exercise. Lorcaserin activates some receptors in the hippocampus promoting weight loss through satiety, while naltrexone is an anti-addiction drug. Liraglutide is part of a family of drugs known as glucagon-like peptide-1 receptor agonists that stimulate insulin secretion when required (after eating), increase satiety, and delay gastric emptying. These kind of drugs are also widely used in the treatment of diabetes type 2, and are considered a safer approach to the treatment of obesity as it does not affect the central nervous system directly. The SCALE clinical trial, in which a Mexican clinical research site participated along with other 90 centers across the world to evaluate the effect of Liraglutide on body weight, found that participants lost 8% of body weight after one year of administration of 3 mg of Liraglutide, and at least 63% of the patients lost 5% of body weight. Liraglutide is commercialized under the name of Saxenda, by Novo Nordisk, and was approved in Mexico late in 2015. Beloranib is an entirely new therapy that is currently undergoing clinical evaluation as an obesity therapy due to its ability to block liver production of fat and enhances utilization of fat as an energy source.
Experts recommend pharmacotherapy to be administered along with dietary intervention and exercise on an individualized basis. Finally, people have to be aware that a magic weight loss cure does not exist and that no treatment is free from side effects.
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