1
|
Chin GC, Potter AW, Friedl KE. Body mass index is a barrier to obesity treatment. Front Endocrinol (Lausanne) 2024; 15:1444568. [PMID: 39149118 PMCID: PMC11324493 DOI: 10.3389/fendo.2024.1444568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024] Open
Abstract
The Food and Drug Administration's (FDA) obesity drug guidance is set on the basis of body mass index (BMI), with thresholds of either BMI ≥30 or BMI ≥27 kg/m2 with weight-related comorbidities. While BMI is associated with obesity-related health outcomes, there are known limitations to use as a direct measure of body fat or metabolic health, and the American Medical Association has highlighted limitations of BMI in assessing individual obesity risks. BMI thresholds impose a barrier to treatment. In a sample from the NHANES dataset (n=6,646 men and women), 36% of individuals with metabolic syndrome (MetS) may not be eligible for obesity pharmacotherapy. This analysis provides quantifiable justification for refinement of the BMI treatment criteria with a more holistic assessment of individual obesity-related disease risk.
Collapse
Affiliation(s)
- Geoffrey C Chin
- Thermal and Mountain Medicine Division, United States (U.S.) Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Adam W Potter
- Thermal and Mountain Medicine Division, United States (U.S.) Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Karl E Friedl
- Office of the Senior Scientist, United States (U.S.) Army Research Institute of Environmental Medicine, Natick, MA, United States
| |
Collapse
|
2
|
Yanovski SZ, Yanovski JA. Approach to Obesity Treatment in Primary Care: A Review. JAMA Intern Med 2024; 184:818-829. [PMID: 38466272 DOI: 10.1001/jamainternmed.2023.8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Importance More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed. Observations Lifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences. Conclusions and Relevance Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.
Collapse
Affiliation(s)
- Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
3
|
Powell LH, Daniels BT, Drees BM, Karavolos K, Lohse B, Masters KS, Nicklas JM, Ruder EH, Suzuki S, Trabold N, Zimmermann LJ. Enhancing Lifestyles in the Metabolic syndrome (ELM) multisite behavioral efficacy trial. Design and baseline cohort. Am Heart J 2024; 270:136-155. [PMID: 38215918 DOI: 10.1016/j.ahj.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches. METHODS This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness. RESULTS The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%). CONCLUSIONS The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.
Collapse
|
4
|
Fox CK, Vock DM, Sherwood NE, Gross AC, Ryder JR, Bensignor MO, Bomberg EM, Sunni M, Bramante CT, Jacobs N, Raatz SJ, Kelly AS. SMART use of medications for the treatment of adolescent severe obesity: A sequential multiple assignment randomized trial protocol. Contemp Clin Trials 2024; 138:107444. [PMID: 38219798 PMCID: PMC11037878 DOI: 10.1016/j.cct.2024.107444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Severe obesity is a complex, chronic disease affecting nearly 9% of adolescents in the U.S. Although the current mainstay of treatment is lifestyle therapy, pediatric clinical practice guidelines recommend the addition of adjunct anti-obesity medication (AOM), such as phentermine and topiramate. However, guidance regarding when adjunct AOM should be started and how AOM should be used is unclear. Furthermore, an inherent limitation of current treatment guidelines is their "one-size-fits-all" approach, which does not account for the heterogeneous nature of obesity and high degree of patient variability in response to all interventions. METHODS This paper describes the study design and methods of a sequential multiple assignment randomized trial (SMART), "SMART Use of Medications for the Treatment of Adolescent Severe Obesity." The trial will examine 1) when to start AOM (specifically phentermine) in adolescents who are not responding to lifestyle therapy and 2) how to modify AOM when there is a sub-optimal response to the initial pharmacological intervention (specifically, for phentermine non-responders, is it better to add topiramate to phentermine or switch to topiramate monotherapy). Critically, participant characteristics that may differentially affect response to treatment will be assessed and evaluated as potential moderators of intervention efficacy. CONCLUSION Data from this study will be used to inform the development of an adaptive intervention for the treatment of adolescent severe obesity that includes empirically-derived decision rules regarding when and how to use AOM. Future research will test this adaptive intervention against standard "one-size-fits-all" treatments.
Collapse
Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America.
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States of America
| | - Amy C Gross
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, United States of America; Northwestern Feinberg School of Medicine, United States of America
| | - Megan O Bensignor
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Muna Sunni
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Nina Jacobs
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Sarah J Raatz
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| |
Collapse
|
5
|
Chen K, Chen L, Shan Z, Wang G, Qu S, Qin G, Yu X, Xin W, Hsieh TH, Mu Y. Beinaglutide for weight management in Chinese individuals with overweight or obesity: A phase 3 randomized controlled clinical study. Diabetes Obes Metab 2024; 26:690-698. [PMID: 37945546 DOI: 10.1111/dom.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
AIM To investigate the efficacy and safety of beinaglutide as an adjunct to lifestyle intervention among non-diabetic Chinese individuals with overweight or obesity. METHODS This multicentre, randomized, double-blind, placebo-controlled trial (ChiCTR1900023428) included 427 Chinese adults with a body mass index of 28 kg/m2 or higher (obesity) or 24-27.9 kg/m2 (overweight) with weight-related complications. Patients were randomized in a 2:1 ratio to receive 0.2 mg of beinaglutide (subcutaneous) thrice daily or placebo for 16 weeks. Co-primary endpoints were body weight change and the proportion of patients with a weight reduction of 5% or more. RESULTS Mean body weight change from baseline to week 16 was -6.0% and -2.4% in the beinaglutide (n = 282) and placebo (n = 138) groups, respectively; the mixed model repeated measures difference was -3.6% (95% confidence interval: -4.6% to -2.6%; P < .0001). At week 16, more beinaglutide-treated patients achieved a weight reduction of 5% or more (58.2% vs. 25.4% [placebo], odds ratio: 4.4; P < .0001) and of 10% or more (21.3% vs. 5.1% [placebo], odds ratio: 5.5; P < .0001). Beinaglutide also resulted in greater waist circumference reduction (difference: -1.81 cm; P < .01). The weight regain rate 12 weeks after beinaglutide treatment was 0.78%. Nausea (transient and mild-to-moderate) was the most common adverse event in the beinaglutide group (49.3% vs. 7.1% [placebo]). More patients receiving beinaglutide discontinued treatment because of adverse events (5.9% vs. 0.7% [placebo]). Pancreatitis or an increased resting heart rate was not observed in the beinaglutide group. CONCLUSION Beinaglutide combined with lifestyle intervention resulted in significant and clinically meaningful weight reduction with good tolerance in non-diabetic Chinese individuals with overweight or obesity.
Collapse
Affiliation(s)
- Kang Chen
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan, China
| | - Zhongyan Shan
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guixia Wang
- The First Hospital of Jilin University, Jilin, China
| | - Shen Qu
- Shanghai Tenth People's Hospital, Shanghai, China
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiquan Xin
- Shanghai Benemae Pharmaceutical Corporation, Shanghai, China
| | - Tsung-Han Hsieh
- Shanghai Benemae Pharmaceutical Corporation, Shanghai, China
| | - Yiming Mu
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
6
|
Heymsfield SB. Dietary Supplements for Weight Loss. Gastroenterol Clin North Am 2023; 52:457-467. [PMID: 37197886 DOI: 10.1016/j.gtc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The Federal Drug Administration has approved, following rigorous testing, 6 pharmacologic agents and one drug in device form for the management of overweight and obesity. Myriad products that purport to act on physiological mechanisms leading to weight loss also pervade the market with minimal regulatory oversight. Systematic reviews and meta-analyses of these products and their ingredients fail to establish any as meaningfully effective at the clinical level. Moreover, safety concerns prevail with adulteration, hypersensitivity reactions, and recognized adverse reactions. Lifestyle, pharmacologic, and bariatric surgical treatments are increasingly available, effective, and safe management tools for practitioners who should council patients, many of whom are susceptible to misinformation, on the lack effective and safe dietary supplements for weight loss.
Collapse
Affiliation(s)
- Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| |
Collapse
|
7
|
Playdon MC, Hardikar S, Karra P, Hoobler R, Ibele AR, Cook KL, Kumar A, Ippolito JE, Brown JC. Metabolic and bariatric surgery and obesity pharmacotherapy for cancer prevention: current status and future possibilities. J Natl Cancer Inst Monogr 2023; 2023:68-76. [PMID: 37139980 PMCID: PMC10157771 DOI: 10.1093/jncimonographs/lgad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 01/19/2023] [Indexed: 05/05/2023] Open
Abstract
Obesity is a chronic, relapsing, progressive disease of excess adiposity that increases the risk of developing at least 13 types of cancer. This report provides a concise review of the current state of the science regarding metabolic and bariatric surgery and obesity pharmacotherapy related to cancer risk. Meta-analyses of cohort studies report that metabolic and bariatric surgery is independently associated with a lower risk of incident cancer than nonsurgical obesity care. Less is known regarding the cancer-preventive effects of obesity pharmacotherapy. The recent approval and promising pipeline of obesity drugs will provide the opportunity to understand the potential for obesity therapy to emerge as an evidence-based cancer prevention strategy. There are myriad research opportunities to advance our understanding of how metabolic and bariatric surgery and obesity pharmacotherapy may be used for cancer prevention.
Collapse
Affiliation(s)
- Mary C Playdon
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Prasoona Karra
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Rachel Hoobler
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Anna R Ibele
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Katherine L Cook
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanika Kumar
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin C Brown
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Louisiana State University Health Sciences Center New Orleans School of Medicine, New Orleans, LA, USA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
8
|
Chakhtoura M, Mantzoros CS. Advances in physiology, design and development of novel medications changing the landscape of obesity pharmacotherapy. Metabolism 2023; 142:155531. [PMID: 36870600 DOI: 10.1016/j.metabol.2023.155531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christos S Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare system, Harvard Medical School, Boston, MA.
| |
Collapse
|
9
|
Berger G, Corris JD, Fields SE, Hao L, Scarpa LL, Bello NT. Systematic Review of Binge Eating Rodent Models for Developing Novel or Repurposing Existing Pharmacotherapies. Biomolecules 2023; 13:biom13050742. [PMID: 37238615 DOI: 10.3390/biom13050742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Recent advances in developing and screening candidate pharmacotherapies for psychiatric disorders have depended on rodent models. Eating disorders are a set of psychiatric disorders that have traditionally relied on behavioral therapies for effective long-term treatment. However, the clinical use of Lisdexamfatamine for binge eating disorder (BED) has furthered the notion of using pharmacotherapies for treating binge eating pathologies. While there are several binge eating rodent models, there is not a consensus on how to define pharmacological effectiveness within these models. Our purpose is to provide an overview of the potential pharmacotherapies or compounds tested in established rodent models of binge eating behavior. These findings will help provide guidance for determining pharmacological effectiveness for potential novel or repurposed pharmacotherapies.
Collapse
Affiliation(s)
- Gregory Berger
- Endocrinology and Animal Biosciences Graduate Program, Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Joshua D Corris
- Endocrinology and Animal Biosciences Graduate Program, Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Spencer E Fields
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
- Nutritional Sciences Graduate Program, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Lihong Hao
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Lori L Scarpa
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Nicholas T Bello
- Endocrinology and Animal Biosciences Graduate Program, Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
- Rutgers Brain Health Institute, Rutgers University and Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| |
Collapse
|
10
|
Costa RODA, Passos TS, Silva EMDS, dos Santos NCS, Morais AHDA. Encapsulated Peptides and Proteins with an Effect on Satiety. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1166. [PMID: 37049259 PMCID: PMC10097199 DOI: 10.3390/nano13071166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
The world scenario has undergone a nutritional transition in which some countries have left the reality of malnutrition and now face an epidemic of excess body weight. Researchers have been looking for strategies to reverse this situation. Peptides and proteins stand out as promising molecules with anti-obesity action. However, oral administration and passage through the gastrointestinal tract face numerous physiological barriers that impair their bioactive function. Encapsulation aims to protect the active substance and modify the action, one possibility of potentiating anti-obesity activity. Research with encapsulated peptides and proteins has demonstrated improved stability, delivery, controlled release, and increased bioactivity. However, it is necessary to explore how proteins and peptides affect weight loss and satiety, can impact the nutritional status of obesity, and how encapsulation can enhance the bioactive effects of these molecules. This integrative review aimed to discuss how the encapsulation of protein molecules impacts the nutritional status of obesity. From the studies selected following pre-established criteria, it was possible to infer that the encapsulation of proteins and peptides can contribute to greater efficiency in reducing weight gain, changes in adipose tissue function, and lower hormone levels that modulate appetite and body weight in animals with obesity.
Collapse
Affiliation(s)
- Rafael O. de A. Costa
- Biochemistry and Molecular Biology Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Thaís S. Passos
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Eloyse Mikaelly de S. Silva
- Nutrition Course, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | | | - Ana Heloneida de A. Morais
- Biochemistry and Molecular Biology Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Nutrition Course, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| |
Collapse
|
11
|
Cornejo-Estrada A, Nieto-Rodríguez C, León-Figueroa DA, Moreno-Ramos E, Cabanillas-Ramirez C, Barboza JJ. Efficacy of Liraglutide in Obesity in Children and Adolescents: Systematic Review and Meta-Analysis of Randomized Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020208. [PMID: 36832337 PMCID: PMC10010327 DOI: 10.3390/children10020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/10/2022] [Accepted: 12/25/2022] [Indexed: 01/27/2023]
Abstract
In the past few decades, childhood obesity has become a significant global health issue, impacting around 107.7 million children and adolescents globally. There is currently minimal usage of pharmacological therapies for childhood obesity in the pediatric population. This research assessed the efficacy of liraglutide in treating childhood and adolescent obesity. Until 20 October 2022, a systematic literature review was done utilizing PubMed, Scopus, Web of Science, and Embase databases. The search phrases "liraglutide", "pediatric obesity", "children", and "adolescents" were utilized. Using the search method, a total of 185 articles were found. Three studies demonstrating liraglutide's effectiveness in treating child and adolescent obesity were included. The selected research was done in the United States. As an intervention, liraglutide was administered to 296 participants at a maximal dosage of 3.0 mg. All examined trials were in phase 3. This comprehensive analysis revealed no clinically significant differences between liraglutide and body weight (kg; MD -2.62; 95%CI -6.35 to 1.12; p = 0.17) and body mass index (kg/m2; MD -0.80; 95%CI -2.33 to 0.73, p = 0.31). There was no evidence that liraglutide increased hypoglycemia episodes (RR 1.08; 95%CI 0.37 to 3.15; p = 0.79), or side consequences. However, it was shown that the medicine might help reduce BMI and weight combined with a healthy diet and regular exercise. A lifestyle change may have favorable consequences that will be assessed in the future for adjunctive therapy. PROSPERO database (CRD42022347472).
Collapse
Affiliation(s)
- Alejandra Cornejo-Estrada
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
| | - Carlos Nieto-Rodríguez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
| | - Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru;
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
| | - Emilly Moreno-Ramos
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima 15046, Peru
| | - Cielo Cabanillas-Ramirez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
| | - Joshuan J. Barboza
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima 15046, Peru
- Correspondence: ; Tel.: +51-992108520
| |
Collapse
|
12
|
Agrawal S, Klarqvist MDR, Diamant N, Stanley TL, Ellinor PT, Mehta NN, Philippakis A, Ng K, Claussnitzer M, Grinspoon SK, Batra P, Khera AV. BMI-adjusted adipose tissue volumes exhibit depot-specific and divergent associations with cardiometabolic diseases. Nat Commun 2023; 14:266. [PMID: 36650173 PMCID: PMC9844175 DOI: 10.1038/s41467-022-35704-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
For any given body mass index (BMI), individuals vary substantially in fat distribution, and this variation may have important implications for cardiometabolic risk. Here, we study disease associations with BMI-independent variation in visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) fat depots in 40,032 individuals of the UK Biobank with body MRI. We apply deep learning models based on two-dimensional body MRI projections to enable near-perfect estimation of fat depot volumes (R2 in heldout dataset = 0.978-0.991 for VAT, ASAT, and GFAT). Next, we derive BMI-adjusted metrics for each fat depot (e.g. VAT adjusted for BMI, VATadjBMI) to quantify local adiposity burden. VATadjBMI is associated with increased risk of type 2 diabetes and coronary artery disease, ASATadjBMI is largely neutral, and GFATadjBMI is associated with reduced risk. These results - describing three metabolically distinct fat depots at scale - clarify the cardiometabolic impact of BMI-independent differences in body fat distribution.
Collapse
Affiliation(s)
- Saaket Agrawal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Nathaniel Diamant
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Takara L Stanley
- Metabolism Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Philippakis
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Eric and Wendy Schmidt Center, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Melina Claussnitzer
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven K Grinspoon
- Metabolism Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amit V Khera
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Verve Therapeutics, Cambridge, MA, USA.
| |
Collapse
|
13
|
Arlinghaus KR, Cepni AB, Helbing RR, Goodman LP, Ledoux TA, Johnston CA. Response to school-based interventions for overweight and obesity: A systematic scoping review. Clin Obes 2022; 12:e12557. [PMID: 36128952 PMCID: PMC9669238 DOI: 10.1111/cob.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 12/30/2022]
Abstract
Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.
Collapse
Affiliation(s)
- Katherine R. Arlinghaus
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Aliye B. Cepni
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
| | | | - Lenora P. Goodman
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Tracey A. Ledoux
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
| | - Craig A. Johnston
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
| |
Collapse
|
14
|
Nguedjo MW, Ngondi JL, Ntentie FR, Kingue Azantsa BG, Ntepe Mbah JL, Oben JE. Clinical characteristics and classification of Cameroonians with obesity and metabolically normal phenotype in the West region of Cameroon. Heliyon 2022; 8:e11652. [PMID: 36425423 PMCID: PMC9678690 DOI: 10.1016/j.heliyon.2022.e11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/08/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to classify and suggest an adequate definition of the metabolically normal phenotype among Cameroonians with obesity in the western Region of Cameroon. A cross-sectional study was conducted in the West Cameroon Region from August 2016 to August 2017. A total of 324 subjects with BMI >27 kg/m2, aged of 20 years and older, and not treated for cardiometabolic diseases were included in the study. Sociodemographic and clinical parameters of the subjects were collected. Four definitions of metabolic status were tested to suggest the definition that best identifies the subjects with obesity but metabolically normal phenotype (MNO) in the study. The prevalence of the MNO phenotype varied from 2.50% to 29.60% according to the definitions used. According to the individual definitions, the prevalence of the MNO phenotype was 29.60% according to Hinnouho, 16.00% according to Mbanya, 7.40% according to Meigs and 2.50% according to Widman. Markers of inflammatory profile (high sensitivity C-reactive protein and tumor necrosis factor-alpha), carbohydrate homeostasis (fasting glucose and homeostasis model assessment), markers of lipid profile (total cholesterol and triglyceride), systolic blood pressure, nitric oxide, adiposity indices (Waist circumference and waist to hip ratio) were significantly lower in MNO subjects for the majority of definitions (p < 0.05). The modified Hinnouho definition showed better specificity (60.90%) and sensitivity (12.10%) for an area under the ROC curve of 0.98. The degree of agreement was low between the different pairs of definition of the MNO phenotype (Kappa< 0.61). There is poor agreement between the different definitions of the MNO phenotype among Cameroonians with obesity. Therefore, the adoption of a universal definition of MNO phenotype should be proposed to facilitate the management of metabolic health in people with obesity.
Collapse
Affiliation(s)
- Maxwell Wandji Nguedjo
- Department of Biochemistry, Faculty of Sciences, University of Yaounde 1, P. O. Box 812, Yaounde, Cameroon
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, P. O. Box 13033, Yaounde, Cameroon
| | - Judith Laure Ngondi
- Department of Biochemistry, Faculty of Sciences, University of Yaounde 1, P. O. Box 812, Yaounde, Cameroon
| | | | - Boris Gabin Kingue Azantsa
- Department of Biochemistry, Faculty of Sciences, University of Yaounde 1, P. O. Box 812, Yaounde, Cameroon
| | - Javeres Leonel Ntepe Mbah
- Laboratory of Human Metabolism and Non-Communicable Disease, Institute of Medical Research and Medicinal Plant Studies, P. O. Box 13033, Yaounde, Cameroon
- Department of Biosciences, COMSATS University Islamabad, Chak Shahzad, Islamabad 45550, Pakistan
| | - Julius Enyong Oben
- Department of Biochemistry, Faculty of Sciences, University of Yaounde 1, P. O. Box 812, Yaounde, Cameroon
| |
Collapse
|
15
|
Townsend MJ, Claridy MD, Bajaj SS, Tu L, Stanford FC. Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S. Am J Prev Med 2022; 63:513-520. [PMID: 35613976 PMCID: PMC9940942 DOI: 10.1016/j.amepre.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability. METHODS This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care. RESULTS From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy. CONCLUSIONS Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.
Collapse
Affiliation(s)
| | - Mechelle D Claridy
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Simar S Bajaj
- Department of the History of Science, Harvard University, Cambridge, Massachusetts
| | - Lucy Tu
- Department of Sociology, Harvard University, Cambridge, Massachusetts
| | - Fatima C Stanford
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
16
|
Oo WM, Mobasheri A, Hunter DJ. A narrative review of anti-obesity medications for obese patients with osteoarthritis. Expert Opin Pharmacother 2022; 23:1381-1395. [PMID: 35855642 DOI: 10.1080/14656566.2022.2104636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The prevalence of both obesity and osteoarthritis (OA) are increasing worldwide (twindemic), and the association between the two chronic diseases is also well-established. AREAS COVERED : In this narrative review, we will briefly describe the double burdens of both diseases, the impact of weight loss or gain on OA incidence and structural progression and discuss the biomechanical and anti-inflammatory mechanisms mediating these effects. FDA-approved anti-obesity drugs are summarized in terms of their clinical efficacy and safety profile, and the completed or ongoing phase 2/3 clinical trials of such drugs in OA patients with obesity are examined. EXPERT OPINION : We will discuss the perspectives related to principles of prescription of anti-obesity drugs, the potential role of phenotype-guided approach, time to drug effects in clinical trials, sustainability of weight loss based on the real-world studies, the importance of concomitant therapies such as dieting and exercises, and the role of weight loss on non-weight bearing OA joints. Although obesity is the major risk factor for OA pathogenesis and progression, and there are a variety of anti-obesity medications on the market, research on the use of these disease-modifying drugs in OA (DMOAD) is still sparse..
Collapse
Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.,Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
17
|
Johnson O, Gerald LB, Harvey J, Roy G, Hazucha H, Large C, Burke A, McCormack M, Wise RA, Holbrook JT, Dixon AE. An Online Weight Loss Intervention for People With Obesity and Poorly Controlled Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1577-1586.e3. [PMID: 35304842 PMCID: PMC9188993 DOI: 10.1016/j.jaip.2022.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND Weight loss might improve asthma control in people with obesity. However, people with asthma might have particular challenges losing weight and the amount of weight loss needed to improve asthma control is not clear. OBJECTIVES To pilot-test an online weight loss intervention and to estimate the impact of weight loss on asthma control. METHODS We performed a 6-month, single-arm, futility trial of an online weight loss intervention at 2 centers. To reject the assumption of futility, 9 or more participants had to lose at least 5% of their body weight. We also assessed the association between weight loss (≥5%) and asthma outcomes. RESULTS Forty-three participants (85% women) started the weight loss intervention. The median and interquartile range for the body mass index was 40.3 kg/m2 (range 34.7-46.8 kg/m2), and 14 (range 12-17 kg/m2) for the Asthma Control Test score. At 6 months, 10 participants (23%; 95% CI 12%-39%) lost at least 5% of their initial weight. Weight loss of at least 5% was associated with a clinically and statistically significant improvements in their Asthma Control Test (median [interquartile range] increase of 3 [1 to 7]; P < .05), Marks Asthma Quality of Life Score (-9.5 [-18 to -3]; P = .008), and their general health-related quality of life score (RAND-36; improved by 9.4 [2.8 to 22.5]; P =.014). CONCLUSIONS An online weight loss intervention has the potential to meet U.S. Food and Drug Administration guidance for product evaluation (at least a 5% weight loss in 35% of people) for treating obesity, and is associated with a clinically significant improvement in asthma control, quality of life, and overall health-related quality of life.
Collapse
Affiliation(s)
- Olivia Johnson
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Lynn B Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Tucson, Ariz; Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Jean Harvey
- Department of Nutrition and Food Science, College of Agriculture and Life Sciences, University of Vermont, Burlington, Vt
| | - Gem Roy
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Heather Hazucha
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Chelsey Large
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Alyce Burke
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert A Wise
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Janet T Holbrook
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Anne E Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vt.
| |
Collapse
|
18
|
Heal DJ, Smith SL. Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology. J Psychopharmacol 2022; 36:680-703. [PMID: 34318734 PMCID: PMC9150143 DOI: 10.1177/02698811211032475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Binge-eating disorder (BED) is a common psychiatric condition with adverse psychological and metabolic consequences. Lisdexamfetamine (LDX) is the only approved BED drug treatment. New drugs to treat BED are urgently needed. METHODS A comprehensive review of published psychopathological, pharmacological and clinical findings. RESULTS The evidence supports the hypothesis that BED is an impulse control disorder with similarities to ADHD, including responsiveness to catecholaminergic drugs, for example LDX and dasotraline. The target product profile (TPP) of the ideal BED drug combines treating the psychopathological drivers of the disorder with an independent weight-loss effect. Drugs with proven efficacy in BED have a common pharmacology; they potentiate central noradrenergic and dopaminergic neurotransmission. Because of the overlap between pharmacotherapy in attention deficit hyperactivity disorder (ADHD) and BED, drug-candidates from diverse pharmacological classes, which have already failed in ADHD would also be predicted to fail if tested in BED. The failure in BED trials of drugs with diverse pharmacological mechanisms indicates many possible avenues for drug discovery can probably be discounted. CONCLUSIONS (1) The efficacy of drugs for BED is dependent on reducing its core psychopathologies of impulsivity, compulsivity and perseveration and by increasing cognitive control of eating. (2) The analysis revealed a large number of pharmacological mechanisms are unlikely to be productive in the search for effective new BED drugs. (3) The most promising areas for new treatments for BED are drugs, which augment noradrenergic and dopaminergic neurotransmission and/or those which are effective in ADHD.
Collapse
Affiliation(s)
- David J Heal
- David J Heal, DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
| | | |
Collapse
|
19
|
El Hajj EC, El Hajj MC, Sykes B, Lamicq M, Zile MR, Malcolm R, O'Neil PM, Litwin SE. Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e022930. [PMID: 34713711 PMCID: PMC8751835 DOI: 10.1161/jaha.121.022930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Obesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity. Methods and Results Patients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m2 were offered enrollment in an established 15-week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6-minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m2), 74% of whom lost >5% of their baseline body weight following the 15-week program. At 15 weeks, mean 6-minute walk distance increased from 223 to 281 m (P=0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks (P<0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score (r=0.452; P=0.000) and 6-minute walk distance (r=-0.388; P<0.001). Conclusions In a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15-week program. This is associated with significant improvements in quality of life and exercise capacity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02911337.
Collapse
Affiliation(s)
- Elia C El Hajj
- Department of Physiology Louisiana State University New Orleans LA
| | | | - Brandon Sykes
- Division of Cardiology Medical University of South Carolina Charleston SC
| | - Melissa Lamicq
- Division of Cardiology Medical University of South Carolina Charleston SC
| | - Michael R Zile
- Division of Cardiology Medical University of South Carolina Charleston SC.,Ralph J. Johnson Veterans Affairs Medical Center Charleston SC
| | - Robert Malcolm
- Department of Psychiatry and Behavioral Sciences Weight Management Center Medical University of South Carolina Charleston SC
| | - Patrick M O'Neil
- Department of Psychiatry and Behavioral Sciences Weight Management Center Medical University of South Carolina Charleston SC
| | - Sheldon E Litwin
- Division of Cardiology Medical University of South Carolina Charleston SC.,Ralph J. Johnson Veterans Affairs Medical Center Charleston SC
| |
Collapse
|
20
|
Finer N. Future directions in obesity pharmacotherapy. Eur J Intern Med 2021; 93:13-20. [PMID: 34024701 DOI: 10.1016/j.ejim.2021.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
There is a growing unmet need for more effective treatment of obesity and its complications. While current anti-obesity medications are effective and offer real clinical benefits over diet and lifestyle interventions, they cannot meet the levels of efficacy and reduction of hard endpoint outcomes seen with bariatric surgery. As knowledge on the control of body weight unravels, the complexity of this physiology opens the opportunity to new druggable targets. Currently, gut peptide analogues such as semaglutide, a glucagon like peptide-1 (GLP-1) receptor agonist, and the dual agonist GLP-1 and gastric inhibitory polypeptide (GIP) tirzepatide are the furthest advanced in clinical development and seem likely to meet current regulatory requirements within the next year or so. However, current regulatory requirements are out of step with the efficacy of new compounds and concepts relating to obesity and its complications. Many other drugs in early development will target different pathways of energy balance, raising the possibility of drug combinations to maximise efficacy as for other chronic disease such as hypertension and diabetes. This will allow more complex and personalised guidelines to evolve.
Collapse
Affiliation(s)
- Nick Finer
- Hon. Clinical Professor National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, Nomura House, 1 St Martin's le Grand, London EC1A 4NP, UK.
| |
Collapse
|
21
|
Voils CI, Pendergast J, Hale SL, Gierisch JM, Strawbridge EM, Levine E, McVay MA, Reed SD, Yancy WS, Shaw RJ. A randomized feasibility pilot trial of a financial incentives intervention for dietary self-monitoring and weight loss in adults with obesity. Transl Behav Med 2021; 11:954-969. [PMID: 33245118 DOI: 10.1093/tbm/ibaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Financial incentives could be used to improve adherence to behavioral weight loss interventions, increasing their effectiveness. This Phase IIb randomized pilot study evaluated the feasibility and acceptability of a study protocol for providing financial incentives for dietary self-monitoring and/or weight loss. Community-dwelling adults with obesity were enrolled in a 24 week, group-based weight loss program. Participants were randomized in a 2 × 2 factorial design to receive financial incentives for both dietary self-monitoring and weekly weight loss, just one, or neither. Participants could earn up to $300, evolving from fixed weekly payments to intermittent, variable payments. The notice of reward was provided by text message. The study was conducted in three successive cohorts to evaluate study procedure changes, including dietary approach, recruitment and retention strategies, text messaging, and incentives. Descriptive statistics calculated separately for each cohort described study performance relative to predefined targets for recruitment, including minority representation; retention; adherence; and weight loss. Acceptability was assessed via postintervention qualitative interviews. In Cohort 1 (n = 34), a low-carbohydrate diet was used. Recruitment, retention, adherence, and weight loss were adequate, but minority representation was not. For Cohort 2 (n = 31), employing an additional recruitment method and switching to a reduced-calorie diet yielded adequate recruitment, minority representation, retention, and adherence but less weight loss. Returning to a low-carbohydrate diet in Cohort 3 (n = 28) yielded recruitment, minority representation, retention, adherence, and weight loss similar to Cohort 2. Participant feedback informed changes to text message timing and content and incentive amount. Through successive cohorts, we optimized recruitment and retention strategies and text messaging. An adequately powered trial is warranted to evaluate the efficacy of these incentive structures for reducing weight. The trial registration number is NCT02691260.
Collapse
Affiliation(s)
- Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Research Service, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Sarah L Hale
- School of Medicine, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | - Megan A McVay
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Shelby D Reed
- School of Medicine, Duke University, Durham, NC, USA
| | - William S Yancy
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, USA
| |
Collapse
|
22
|
Mehta M, Istfan NW, Apovian CM. Obesity: Overview of Weight Management. Endocr Pract 2021; 27:626-635. [PMID: 33901648 DOI: 10.1016/j.eprac.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is a chronic illness that requires a multifaceted personalized treatment approach. METHODS & FINDINGS Using current guidelines and recent studies in weight management, this article reviews the multiple components of weight management: lifestyle intervention (dietary intervention, physical activity, and behavioral interventions), pharmacotherapy, endoscopic procedures, and surgical procedures. This review briefly discusses specific diets and dietary strategies, compensatory mechanisms acting against weight loss, recent changes to Food and Drug Administration approved antiobesity medications, and technological advances in weight management delivery. CONCLUSION Current literature is lacking large studies on the safety and efficacy of combination therapies involving pharmacotherapy plus 1 or more procedures.
Collapse
Affiliation(s)
- Meetal Mehta
- Brigham and Women's Hospital, Center for Weight Management and Wellness, Section of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts.
| | - Nawfal W Istfan
- Brigham and Women's Hospital, Center for Weight Management and Wellness, Section of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts
| | - Caroline M Apovian
- Brigham and Women's Hospital, Center for Weight Management and Wellness, Section of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
23
|
Abstract
In recent years, plenty of researches have reported in obese individuals with abnormal brain processes implicated in homeostatic regulation, reward, emotion, memory, attention, and executive function in eating behaviors. Thus, treating obesity cannot remain "brainless." Behavioral and psychological interventions activate the food reward, attention, and motivation system, leading to minimal weight loss and high relapse rates. Pharmacotherapy is an effective weight loss method and regulate brain activity but with concerns about its brain function safety problems. Obesity surgery, the most effective therapy currently available for obesity, shows pronounced effects on brain activity, such as deactivation of reward and attention system, and activation of inhibition control toward food cues. In this review, we present an overview of alterations in the brain after the three common weight loss methods.
Collapse
|
24
|
Dragano NRV, Fernø J, Diéguez C, López M, Milbank E. Reprint of: Recent Updates on Obesity Treatments: Available Drugs and Future Directions. Neuroscience 2020; 447:191-215. [PMID: 33046217 DOI: 10.1016/j.neuroscience.2020.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the last thirty years, obesity has reached epidemic proportions and is now regarded as a major health issue in contemporary society trending to serious economic and social burdens. The latest projections of the World Health Organization are alarming. By 2030, nearly 60% of the worldwide population could be either obese or overweight, highlighting the needs to find innovative treatments. Currently, bariatric surgery is the most effective way to efficiently lower body mass. Although great improvements in terms of recovery and patient care were made in these surgical procedures, bariatric surgery remains an option for extreme forms of obesity and seems unable to tackle obesity pandemic expansion. Throughout the last century, numerous pharmacological strategies targeting either peripheral or central components of the energy balance regulatory system were designed to reduce body mass, some of them reaching sufficient levels of efficiency and safety. Nevertheless, obesity drug therapy remains quite limited on its effectiveness to actually overcome the obesogenic environment. Thus, innovative unimolecular polypharmacology strategies, able to simultaneously target multiple actors involved in the obesity initiation and expansion, were developed during the last ten years opening a new promising avenue in the pharmacological management of obesity. In this review, we first describe the clinical features of obesity-associated conditions and then focus on the outcomes of currently approved drug therapies for obesity as well as new ones expecting to reach the clinic in the near future.
Collapse
Affiliation(s)
- Nathalia R V Dragano
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain.
| | - Johan Fernø
- Hormone Laboratory, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Carlos Diéguez
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain
| | - Miguel López
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain
| | - Edward Milbank
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain.
| |
Collapse
|
25
|
Gadde KM, Atkins KD. The limits and challenges of antiobesity pharmacotherapy. Expert Opin Pharmacother 2020; 21:1319-1328. [PMID: 32292094 PMCID: PMC7523877 DOI: 10.1080/14656566.2020.1748599] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/25/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pharmacotherapy is a useful adjunct when patients with obesity are unable to achieve adequate benefit from lifestyle interventions. AREAS COVERED This review covers the history of antiobesity drugs, efficacy, and risks of currently approved drugs, limits of their usefulness in clinical practice, gaps in knowledge, methodological limitations of clinical trials, and reasons for underutilization. EXPERT OPINION In randomized controlled trials, currently approved antiobesity drugs have yielded an average weight loss ranging from approximately 3% to 9% relative to placebo at 1 year. Inadequate inclusion of racial and ethnic minorities and men, and high dropout rates in clinical trials limit generalizability of these findings to clinical practice. Weight loss achieved with antiobesity drugs is generally associated with lowered glycemia, but improvements in blood pressure and lipid measures tend to be marginal. There is limited evidence for sustained weight loss beyond 1 year and for safety and efficacy of antiobesity drugs in children and adolescents, and in post-bariatric surgery patients. None have demonstrated reduction in major adverse cardiovascular events or other significant disease outcomes. Limited health insurance coverage and negative perceptions of physicians have hindered the utilization of antiobesity drugs.
Collapse
Affiliation(s)
- Kishore M Gadde
- Pennington Biomedical Research Center , Baton Rouge, LA, USA
| | | |
Collapse
|
26
|
Czepiel KS, Perez NP, Campoverde Reyes KJ, Sabharwal S, Stanford FC. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne) 2020; 11:290. [PMID: 32477270 PMCID: PMC7237714 DOI: 10.3389/fendo.2020.00290] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ~6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m2, respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.
Collapse
Affiliation(s)
- Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Numa P. Perez
- Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shreya Sabharwal
- Department of Bioethics, Harvard Medical School, Boston, MA, United States
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
27
|
Dragano NRV, Fernø J, Diéguez C, López M, Milbank E. Recent Updates on Obesity Treatments: Available Drugs and Future Directions. Neuroscience 2020; 437:215-239. [PMID: 32360593 DOI: 10.1016/j.neuroscience.2020.04.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
In the last thirty years, obesity has reached epidemic proportions and is now regarded as a major health issue in contemporary society trending to serious economic and social burdens. The latest projections of the World Health Organization are alarming. By 2030, nearly 60% of the worldwide population could be either obese or overweight, highlighting the needs to find innovative treatments. Currently, bariatric surgery is the most effective way to efficiently lower body mass. Although great improvements in terms of recovery and patient care were made in these surgical procedures, bariatric surgery remains an option for extreme forms of obesity and seems unable to tackle obesity pandemic expansion. Throughout the last century, numerous pharmacological strategies targeting either peripheral or central components of the energy balance regulatory system were designed to reduce body mass, some of them reaching sufficient levels of efficiency and safety. Nevertheless, obesity drug therapy remains quite limited on its effectiveness to actually overcome the obesogenic environment. Thus, innovative unimolecular polypharmacology strategies, able to simultaneously target multiple actors involved in the obesity initiation and expansion, were developed during the last ten years opening a new promising avenue in the pharmacological management of obesity. In this review, we first describe the clinical features of obesity-associated conditions and then focus on the outcomes of currently approved drug therapies for obesity as well as new ones expecting to reach the clinic in the near future.
Collapse
Affiliation(s)
- Nathalia R V Dragano
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain.
| | - Johan Fernø
- Hormone Laboratory, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Carlos Diéguez
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain
| | - Miguel López
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain
| | - Edward Milbank
- NeurObesity Group, Department of Physiology, CiMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 15706, Spain.
| |
Collapse
|
28
|
Ferguson AL, Kok LF, Luong JK, Van Den Bergh M, Bell-Anderson KS, Fazakerley DJ, Byrne SN. Exposure to solar ultraviolet radiation limits diet-induced weight gain, increases liver triglycerides and prevents the early signs of cardiovascular disease in mice. Nutr Metab Cardiovasc Dis 2019; 29:633-638. [PMID: 30956026 DOI: 10.1016/j.numecd.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS Sunlight exposure is associated with a number of health benefits including protecting us from autoimmunity, cardiovascular disease, obesity and diabetes. Animal studies have confirmed that ultraviolet (UV)-B radiation, independently of vitamin D, can limit diet-induced obesity, metabolic syndrome and atherosclerosis. The aim of this study is to investigate whether exposure to the UV radiation contained in sunlight impacts on these disease parameters. METHODS AND RESULTS We have trialled an intervention with solar UV in obese and atherosclerosis-prone mice. We have discovered that solar-simulated UV can significantly limit diet-induced obesity and reduce atheroma development in mice fed a diet high in sugar and fat. The optimal regime for this benefit was exposure once a week to solar UV equivalent to approximately 30 min of summer sun. Exposure to this optimal dose of solar UV also led to a significant increase in liver triglycerides which may protect the liver from damage. CONCLUSION Our results show that the UV contained in sunlight has the potential to prevent and treat chronic disease at sites distant from irradiated skin. A major health challenge going forward will be to harness the power of the sun safely, without risking an increase in skin cancers.
Collapse
Affiliation(s)
- A L Ferguson
- The University of Sydney, Discipline of Infectious Diseases and Immunology, Central Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia; The Centenary Institute, Camperdown, New South Wales, Australia
| | - L F Kok
- The University of Sydney, Discipline of Infectious Diseases and Immunology, Central Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - J K Luong
- The University of Sydney, Discipline of Infectious Diseases and Immunology, Central Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - M Van Den Bergh
- The University of Sydney, Discipline of Infectious Diseases and Immunology, Central Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - K S Bell-Anderson
- The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, New South Wales, Australia
| | - D J Fazakerley
- The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, New South Wales, Australia
| | - S N Byrne
- The University of Sydney, Discipline of Infectious Diseases and Immunology, Central Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia; Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Westmead, New South Wales, Australia.
| |
Collapse
|
29
|
Abstract
The metabolic syndrome (MetS) concept gathers in a single entity a set of metabolic abnormalities that have in common a close relationship with ectopic deposit of lipids, insulin resistance, and chronic low-grade inflammation. It is a valuable teaching tool to help health professionals to understand and integrate the consequences of lipotoxicity and the adverse metabolic consequences of insulin resistance. Also, it is useful to identify subjects with a high risk for having incident type 2 diabetes. Systems biology studies have gained a prominent role in understanding the interaction between adipose tissue dysfunction, insulin action, and the MetS traits and co-morbidities (that is, non-alcoholic steatohepatitis, or NASH). This approach may allow the identification of new therapeutic targets (that is,
de novo lipogenesis inhibitors for NASH). Treatment targets on MetS are the adoption of a healthy lifestyle, weight loss, and the control of the co-morbidities (hyperglycemia, dyslipidemia, arterial hypertension, among others). The long-term goals are the prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes. In the last few decades, new drugs derived from the identification of innovative treatment targets have come on the market. These drugs have positive effects on more than one MetS component (that is, hyperglycemia and weight control). New potential treatment targets are under study.
Collapse
Affiliation(s)
- Carlos A Aguilar-Salinas
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, 64710, Mexico
| | - Tannia Viveros-Ruiz
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Doctorado de Epidemiología Clínica, Universidad Nacional Autónoma de México, Mexico City, 04510, Mexico
| |
Collapse
|
30
|
Gross AC, Kaizer AM, Kelly AS, Rudser KD, Ryder JR, Borzutzky CR, Santos M, Tucker JM, Yee JK, Fox CK. Long and Short of It: Early Response Predicts Longer-Term Outcomes in Pediatric Weight Management. Obesity (Silver Spring) 2019; 27:272-279. [PMID: 30677263 PMCID: PMC6352906 DOI: 10.1002/oby.22367] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to examine whether 1-month BMI improvement is predictive of superior 6- and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. METHODS Participants were 4- to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. RESULTS Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, -2.05 vs. 0.05; %BMI, -5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, -1.87 vs. 0.30; %BMI, -5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1-month responders were 9.64 (95% CI: 5.85-15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49-11.02; P < 0.001) times that of nonresponders at 12 months. CONCLUSIONS In treatment-seeking youth with obesity, early BMI reduction was significantly associated with greater long-term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.
Collapse
Affiliation(s)
- Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alexander M Kaizer
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Claudia R Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Melissa Santos
- The Pediatric Obesity Center, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, USA
| | - Jennifer K Yee
- Department of Pediatrics, Division of Endocrinology, Harbor-UCLA Medical Center, The Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Claudia K Fox
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | |
Collapse
|
31
|
Powell LH, Appelhans BM, Ventrelle J, Karavolos K, March ML, Ong JC, Fitzpatrick SL, Normand P, Dawar R, Kazlauskaite R. Development of a lifestyle intervention for the metabolic syndrome: Discovery through proof-of-concept. Health Psychol 2018; 37:929-939. [PMID: 30234352 PMCID: PMC6589338 DOI: 10.1037/hea0000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim was to describe the early phases of the progressive development of a lifestyle treatment for sustained remission of the metabolic syndrome (MetS) using the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development as a guide. METHODS Early discovery and design phases produced a 3-component (diet, physical activity, stress), group-based lifestyle treatment with an intensive 6-month phase followed by monthly, participant-led maintenance meetings. In the proof-of-concept phase, 26 participants with the MetS (age 53 ± 7 years, 77% female, and 65% ethnic minority) were recruited in a quasi-experimental design to determine if treatment could achieve the prespecified benchmark of MetS remission in ≥50% at 2.5 years. Exploratory outcomes focused on MetS components, weight, and patient-centered benefits on energy/vitality and psychosocial status. RESULTS MetS remission was achieved in 53.8% after a median of 2.5 years. At 2.5 years, an increase of +15.4% reported eating ≥3 servings of vegetables/day, +7.7% engaged in ≥150 minutes of moderate-to-vigorous physical activity/week; and +11.5% reported experiencing no depression in the past 2 weeks. Weight loss ≥5% was achieved by 38.5%, and energy/vitality, negative affect, and social support improved. Median group attendance over 2.5 years was 73.8%. CONCLUSIONS It is plausible that this lifestyle program can produce a remission in the MetS, sustained through 2.5 years. After refinements to enhance precision and strength, progression to feasibility pilot testing and a randomized clinical trial will determine its efficacy as a cost-effective lifestyle option for managing the MetS in the current health care system. (PsycINFO Database Record
Collapse
Affiliation(s)
- Lynda H. Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Bradley M. Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer Ventrelle
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Michelle L. March
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Jason C. Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Patricia Normand
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Rebecca Dawar
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | | |
Collapse
|
32
|
Liss DT, Finch EA, Cooper A, Sheth A, Tejuosho AD, Lancki N, Ackermann RT. One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes Res Clin Pract 2018; 140:36-44. [PMID: 29596950 PMCID: PMC5990453 DOI: 10.1016/j.diabres.2018.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
AIMS To estimate the real-world effects of offering a group-based lifestyle intervention (GLI) to adults with diabetes. METHODS This randomized encouragement trial included adult primary care patients in metropolitan Chicago with type 2 diabetes and body mass index ≥24 kg/m2. Participants were randomized to standard care (brief dietary and lifestyle counseling) or standard care plus being encouraged, but not required, to participate in a free-of-charge GLI offered by the YMCA. The GLI was a group-based adaptation of the Look AHEAD lifestyle intervention. RESULTS Of 331 participants, 167 were randomized to standard care and 164 to the GLI encouragement arm. About one third of participants were non-Hispanic White (34.4%). In the GLI arm, 75 (45.7%) attended ≥1 GLI visits. In the primary intention-to-treat analysis, the effect of GLI encouragement was 0.95% weight loss at six months (95% confidence interval [CI], 0.13-1.77%; P = 0.02), and 1.20% weight loss at 12 months (95% CI, 0.05-2.36%; P = 0.04). At 12 months, there was a 0.30% (3.3 mmol/mol) reduction in hemoglobin A1c, but this result did not achieve statistical significance (P = 0.054). In instrumental variable analysis estimating effects among the subgroup of participants who attended any GLI visits, the effect of GLI attendance was 2.30% weight loss at six months (95% CI, 0.30-4.30%; P = 0.02), and 2.07% weight loss at 12 months (95% CI, 0.25-3.88%; P = 0.02). We detected no significant blood pressure or cholesterol effects. CONCLUSIONS Among adults with type 2 diabetes, a group-based lifestyle intervention in a community-based setting achieved modest weight loss at 6 and 12 months. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01435603.
Collapse
Affiliation(s)
- David T Liss
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Emily A Finch
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew Cooper
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Avani Sheth
- Department of Family and Community Medicine, Cook County Health and Hospitals System, Chicago, IL, United States
| | - Ashantí D Tejuosho
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nicola Lancki
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald T Ackermann
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
33
|
Gomez G, Stanford FC. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Int J Obes (Lond) 2018; 42:495-500. [PMID: 29151591 PMCID: PMC6082126 DOI: 10.1038/ijo.2017.287] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/20/2017] [Accepted: 10/29/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. METHODS We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. RESULTS Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. CONCLUSIONS Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.
Collapse
Affiliation(s)
- G Gomez
- Department of Surgery-Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - FC Stanford
- Weight Center, Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
34
|
Cardiovascular Outcome Trials of Diabetes and Obesity Drugs: Implications for Conditional Approval and Early Phase Clinical Development. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Dong Z, Xu L, Liu H, Lv Y, Zheng Q, Li L. Comparative efficacy of five long-term weight loss drugs: quantitative information for medication guidelines. Obes Rev 2017; 18:1377-1385. [PMID: 29024559 DOI: 10.1111/obr.12606] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 12/22/2022]
Abstract
Quantitative information is scarce in current obesity medication guidelines, and they do not clearly reflect the differences in the efficacy characteristics among various drugs. This study quantitatively assessed the efficacy characteristics of five FDA-approved long-term weight loss drugs. Potentially eligible studies were obtained from public databases. Using the differences in the weight change from baseline between the drug group and the corresponding placebo group as the major indicator of efficacy, a time-effect model was established, and crucial pharmacodynamic parameters, such as the maximal efficacy, drug onset time and rate of body weight regain after the maximal efficacy point, were used to reflect the differences in efficacy among the five drugs. Finally, 50 reports (involving 43,443 participants) were included. After deducting the placebo effects, the maximal efficacies (95% CI) of orlistat (120 mg), lorcaserin, naltrexone-bupropion, phentermine-topiramate (PT, 7.5/46 mg) and liraglutide were -2.94 (-5.82, -1.27), -3.06 (-4.39, -1.71), -6.15 (-9.78, -3.25), -7.45 (-9.76, -3.88) and -5.50 (-10.62, -2.97) kg at weeks 60, 54, 67, 59 and 65 respectively, and their rates of body weight regain were 0.51, 0.48, 0.91, 1.27and 0.43 kg per year respectively. The 1-year dropout rates of orlistat, lorcaserin, naltrexone-bupropion, PT and liraglutide were 29.0, 40.9, 49.1, 34.9 and 24.3% respectively. In addition, a significant dose-effect correlation was observed for orlistat and PT. This study provides valid quantitative information for medication guidelines.
Collapse
Affiliation(s)
- Z Dong
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - L Xu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - H Liu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Y Lv
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Q Zheng
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - L Li
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
36
|
García-Cárceles J, Decara JM, Vázquez-Villa H, Rodríguez R, Codesido E, Cruces J, Brea J, Loza MI, Alén F, Botta J, McCormick PJ, Ballesteros JA, Benhamú B, Rodríguez de Fonseca F, López-Rodríguez ML. A Positive Allosteric Modulator of the Serotonin 5-HT 2C Receptor for Obesity. J Med Chem 2017; 60:9575-9584. [PMID: 29116785 DOI: 10.1021/acs.jmedchem.7b00994] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 5-HT2CR agonist lorcaserin, clinically approved for the treatment of obesity, causes important side effects mainly related to subtype selectivity. In the search for 5-HT2CR allosteric modulators as safer antiobesity drugs, a chemical library from Vivia Biotech was screened using ExviTech platform. Structural modifications of identified hit VA240 in synthesized analogues 6-41 afforded compound 11 (N-[(1-benzyl-1H-indol-3-yl)methyl]pyridin-3-amine, VA012), which exhibited dose-dependent enhancement of serotonin efficacy, no significant off-target activities, and low binding competition with serotonin or other orthosteric ligands. PAM 11 was very active in feeding inhibition in rodents, an effect that was not related to the activation of 5-HT2AR. A combination of 11 with the SSRI sertraline increased the anorectic effect. Subchronic administration of 11 reduced food intake and body weight gain without causing CNS-related malaise. The behavior of compound 11 identified in this work supports the interest of a serotonin 5-HT2CR PAM as a promising therapeutic approach for obesity.
Collapse
Affiliation(s)
- Javier García-Cárceles
- Departamento de Química Orgánica I, Universidad Complutense de Madrid , E-28040 Madrid, Spain
| | - Juan M Decara
- Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario , E-29010 Málaga, Spain
| | - Henar Vázquez-Villa
- Departamento de Química Orgánica I, Universidad Complutense de Madrid , E-28040 Madrid, Spain
| | | | | | | | - José Brea
- Biofarma Research Group, USEF Screening Platform, CIMUS, USC , E-15782 Santiago de Compostela, Spain
| | - María I Loza
- Biofarma Research Group, USEF Screening Platform, CIMUS, USC , E-15782 Santiago de Compostela, Spain
| | - Francisco Alén
- Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario , E-29010 Málaga, Spain
| | - Joaquin Botta
- School of Pharmacy, University of East Anglia , NR4 7TJ Norwich, U.K
| | - Peter J McCormick
- School of Veterinary Medicine, University of Surrey , GU2 7XH Guildford, U.K
| | | | - Bellinda Benhamú
- Departamento de Química Orgánica I, Universidad Complutense de Madrid , E-28040 Madrid, Spain
| | | | - María L López-Rodríguez
- Departamento de Química Orgánica I, Universidad Complutense de Madrid , E-28040 Madrid, Spain
| |
Collapse
|
37
|
Golden A. Current pharmacotherapies for obesity. J Am Assoc Nurse Pract 2017; 29:S43-S52. [DOI: 10.1002/2327-6924.12519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023]
|
38
|
Hwang TJ, Franklin JM, Kesselheim AS. Effect of US Food and Drug Administration's Cardiovascular Safety Guidance on Diabetes Drug Development. Clin Pharmacol Ther 2017; 102:290-296. [PMID: 28390139 DOI: 10.1002/cpt.705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
In 2008, the US Food and Drug Administration (FDA) issued guidance on the need for cardiovascular outcome trials to assess the safety of new diabetes medications. Using two large commercial databases, we evaluated the effect of the FDA's cardiovascular safety guidance on drug development for type 2 diabetes as well as a comparison group of drugs intended to treat other alimentary and metabolic conditions. The FDA's guidance was associated with a 31% differential decrease in the rate of diabetes drugs entering phase II trials, but the remaining drugs were significantly more likely to target novel biological pathways (72% of drugs had novel mechanisms after the guidance vs. 49% before the guidance). No differential changes were observed for phase I and phase III trials. There was no measurable improvement during the study period in glycemic efficacy among investigational products entering phase III trials. This research highlights how regulatory actions can impact pharmaceutical innovation.
Collapse
Affiliation(s)
- T J Hwang
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - J M Franklin
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - A S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
39
|
Marrone AK, Antonino MJ, Silverstein JS, Betz MW, Venkataraman-Rao P, Golding M, Cordray D, Cooper JW. The Regulatory Perspectives on Endoscopic Devices for Obesity. Gastrointest Endosc Clin N Am 2017; 27:327-341. [PMID: 28292410 DOI: 10.1016/j.giec.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The recent increase in US Food and Drug Administration-approved weight-loss devices has diversified obesity treatment options. The regulatory pathways for endoscopically placed weight-loss devices and considerations for clinical trials are discussed, including the benefit-risk paradigm intended to aid in weight-loss-device trial development. Also discussed is the benefit-risk analysis of recently approved endoscopic devices. A strategic priority of the FDA Center for Devices and Radiological Health is to increase the use of patient input in decision making. Thus, we consider how endoscopic weight-loss devices with profiles similar to those that have been approved may be viewed in a patient preference study.
Collapse
Affiliation(s)
- April K Marrone
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA.
| | - Mark J Antonino
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Joshua S Silverstein
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Martha W Betz
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Priya Venkataraman-Rao
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Martin Golding
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Diane Cordray
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| | - Jeffrey W Cooper
- Gastroenterology Devices Branch of the Division of Reproductive Gastro-Renal and Urological Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room G218, Silver Spring, MD 20993-0002, USA
| |
Collapse
|
40
|
Halpern B, Mancini MC. Safety assessment of combination therapies in the treatment of obesity: focus on naltrexone/bupropion extended release and phentermine-topiramate extended release. Expert Opin Drug Saf 2016; 16:27-39. [DOI: 10.1080/14740338.2017.1247807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Bruno Halpern
- Obesity Unit, Department of Endocrinology, Hospital das Clínicas, University of São Paulo (USP), São Paulo, Brazil
| | - Marcio C. Mancini
- Obesity Unit, Department of Endocrinology, Hospital das Clínicas, University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
41
|
Evolution of physicochemical properties of melanin concentrating hormone receptor 1 (MCHr1) antagonists. Bioorg Med Chem Lett 2016; 26:4559-4564. [PMID: 27595423 DOI: 10.1016/j.bmcl.2016.08.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023]
Abstract
One pharmacological principle for the treatment of obesity is blockade of the melanin concentrating hormone receptor 1 (MCHr1), which in rodents has been shown to be strongly associated with food intake and energy expenditure. However, discovery of safe and efficacious MCHr1 antagonists has proved to be complex. So far, six compounds have been progressed into clinical trials, but clinical validation of the concept is still lacking. An account of discovery of the three most recent clinical candidates targeting the MCHr1 receptor is given, with an emphasis on their physicochemical properties.
Collapse
|
42
|
Mohammad S, Ahmad J. Management of obesity in patients with type 2 diabetes mellitus in primary care. Diabetes Metab Syndr 2016; 10:171-181. [PMID: 27117509 DOI: 10.1016/j.dsx.2016.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/09/2016] [Indexed: 01/06/2023]
Abstract
AIMS Obesity and being overweight is the most powerful risk factor accounting for 80-90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care. MATERIAL AND METHODS A systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types. RESULTS AND CONCLUSION Effective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care.
Collapse
Affiliation(s)
| | - Jamal Ahmad
- Centre for Diabetes & Endocrinology, Faculty of Medicine, J. N. Medical College Hospital, A.M.U, Aligarh 202 002, India.
| |
Collapse
|
43
|
Krentz AJ, Fujioka K, Hompesch M. Evolution of pharmacological obesity treatments: focus on adverse side-effect profiles. Diabetes Obes Metab 2016; 18:558-70. [PMID: 26936802 DOI: 10.1111/dom.12657] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/14/2015] [Accepted: 02/27/2016] [Indexed: 12/19/2022]
Abstract
Pharmacotherapy directed toward reducing body weight may provide benefits for both curbing obesity and lowering the risk of obesity-associated comorbidities; however, many weight loss medications have been withdrawn from the market because of serious adverse effects. Examples include pulmonary hypertension (aminorex), cardiovascular toxicity, e.g. flenfluramine-induced valvopathy, stroke [phenylpropanolamine (PPA)], excess non-fatal cardiovascular events (sibutramine), and neuro-psychiatric issues (rimonabant; approved in Europe, but not in the USA). This negative experience has helped mould the current drug development and approval process for new anti-obesity drugs. Differences between the US Food and Drug Administration (FDA) and the European Medicines Agency, however, in perceptions of risk-benefit considerations for individual drugs have resulted in discrepancies in approval and/or withdrawal of weight-reducing medications. Thus, two drugs recently approved by the FDA, i.e. lorcaserin and phentermine + topiramate extended release, are not available in Europe. In contrast, naltrexone sustained release (SR)/bupropion SR received FDA approval, and liraglutide 3.0 mg was recently approved in both the USA and Europe. Regulatory strategies adopted by the FDA to manage the potential for uncommon but potentially serious post-marketing toxicity include: (i) risk evaluation and mitigation strategy programmes; (ii) stipulating post-marketing safety trials; (iii) considering responder rates and limiting cumulative exposure by discontinuation if weight loss is not attained within a reasonable timeframe; and (iv) requiring large cardiovascular outcome trials before or after approval. We chronicle the adverse effects of anti-obesity pharmacotherapy and consider how the history of high-profile toxicity issues has shaped the current regulatory landscape for new and future weight-reducing drugs.
Collapse
Affiliation(s)
- A J Krentz
- Profil Institute for Clinical Research, Chula Vista, CA, USA
| | - K Fujioka
- Center for Weight Management, Department of Diabetes and Endocrinology, Scripps Clinic Del Mar, San Diego, CA, USA
| | - M Hompesch
- Profil Institute for Clinical Research, Chula Vista, CA, USA
| |
Collapse
|
44
|
Pandit A, Pandey AK. Obesity context of type 2 diabetes and medication perspectives. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
45
|
Kelly AS, Fox CK, Rudser KD, Gross AC, Ryder JR. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. Int J Obes (Lond) 2016; 40:1043-50. [PMID: 27113643 DOI: 10.1038/ijo.2016.69] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/22/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022]
Abstract
Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.
Collapse
Affiliation(s)
- A S Kelly
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C K Fox
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - K D Rudser
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - A C Gross
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - J R Ryder
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| |
Collapse
|
46
|
|
47
|
Abstract
There is an urgent need for effective pharmacological therapies to help tackle the growing obesity epidemic and the healthcare crisis it poses. The past 3 years have seen approval of a number of novel anti-obesity drugs. The majority of these influence hypothalamic appetite pathways via dopaminergic or serotoninergic signalling. Some are combination therapies, allowing lower doses to minimize the potential for off-target effects. An alternative approach is to mimic endogenous satiety signals using long-lasting forms of peripheral appetite-suppressing hormones. There is also considerable interest in targeting thermogenesis by brown adipose tissue to increase resting energy expenditure. Obesity pharmacotherapy has seen several false dawns, but improved understanding of the pathways regulating energy balance, and better-designed trials, give many greater confidence that recently approved agents will be both efficacious and safe. Nevertheless, a number of issues from preclinical and clinical development continue to attract debate, and additional large-scale trials are still required to address areas of uncertainty.
Collapse
|
48
|
Johansson A, Löfberg C, Antonsson M, von Unge S, Hayes MA, Judkins R, Ploj K, Benthem L, Lindén D, Brodin P, Wennerberg M, Fredenwall M, Li L, Persson J, Bergman R, Pettersen A, Gennemark P, Hogner A. Discovery of (3-(4-(2-Oxa-6-azaspiro[3.3]heptan-6-ylmethyl)phenoxy)azetidin-1-yl)(5-(4-methoxyphenyl)-1,3,4-oxadiazol-2-yl)methanone (AZD1979), a Melanin Concentrating Hormone Receptor 1 (MCHr1) Antagonist with Favorable Physicochemical Properties. J Med Chem 2016; 59:2497-511. [PMID: 26741166 DOI: 10.1021/acs.jmedchem.5b01654] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A novel series of melanin concentrating hormone receptor 1 (MCHr1) antagonists were the starting point for a drug discovery program that culminated in the discovery of 103 (AZD1979). The lead optimization program was conducted with a focus on reducing lipophilicity and understanding the physicochemical properties governing CNS exposure and undesired off-target pharmacology such as hERG interactions. An integrated approach was taken where the key assay was ex vivo receptor occupancy in mice. The candidate compound 103 displayed appropriate lipophilicity for a CNS indication and showed excellent permeability with no efflux. Preclinical GLP toxicology and safety pharmacology studies were without major findings and 103 was taken into clinical trials.
Collapse
Affiliation(s)
- Anders Johansson
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Christian Löfberg
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Madeleine Antonsson
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Sverker von Unge
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Martin A Hayes
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Robert Judkins
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Karolina Ploj
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Lambertus Benthem
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Daniel Lindén
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Peter Brodin
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Marie Wennerberg
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Marléne Fredenwall
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Lanna Li
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Joachim Persson
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Rolf Bergman
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Anna Pettersen
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Peter Gennemark
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| | - Anders Hogner
- Cardiovascular & Metabolic Diseases iMed and ‡Global Medicines Development, AstraZeneca Gothenburg , 431 83 Mölndal, Sweden
| |
Collapse
|
49
|
Jones JL, Sundwall D. Health Care Systems and National Policy: Role of Leadership in the Obesity Crisis. Prim Care 2016; 43:19-37, vii. [PMID: 26896197 DOI: 10.1016/j.pop.2015.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, defined as a body mass index (BMI) of 30 or higher in adults and BMI in the 95th percentile or higher for children, is epidemic in the United States. The predominant culture of caloric excess and sedentary behaviors contributes to this problem. Obesity increases the risk of many chronic diseases and premature death. The broad response to this costly disease includes efforts from medical providers, local and federal governments, and nongovernmental agencies. Although obesity can be addressed on an individual basis, it is largely recognized as a public health issue.
Collapse
Affiliation(s)
- Jessica Lynn Jones
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA.
| | - David Sundwall
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA
| |
Collapse
|
50
|
Abstract
Medications for obesity management can be divided into 4 groups: antidepressants (naltrexone/bupropion), stimulants (phentermine, phendimetrazine, diethylpropion, phentermine/topiramate), fat blockers (orlistat), and diabetes medications (liraglutide). Each group has specific therapeutic effects, adverse effects, and costs. Two medications are indicated for long-term use in obesity: lorcaserin and orlistat. Other available medications are for short-term use. High cost makes many of these medications inaccessible for underserved and poor patients. Because of misuse potential, many obesity medications are also classified as controlled substances. There are no medications currently approved for use in pregnant or lactating women.
Collapse
|