Medications for weight reduction

Bariatric surgery and weight loss in the short- and long-term: Evidence from NHANES 2015-2018

The present study aimed to examine short- and long-term weight change in a nationally representative sample of US adults who reportedly underwent bariatric surgery. Individuals aged 20-64 at survey from the US National Health and Nutrition Examination Survey 2015-2018 were included in the analyses (n = 6776). The primary comparison groups include 62 participants who underwent bariatric surgery, 1531 eligible but did not receive surgery, and 5183 not eligible for bariatric surgery. After adjusting for demographic characteristics and comorbidity, adults who reported receiving bariatric surgery were 5.0 times (4.0-6.0) more likely to achieve at least 20% weight loss from maximum weight relative to those who were eligible but reported no surgery. The likelihood appeared to be higher when surgery was performed within 10 years (short-term, PR 5.5, 95% CI: 4.0, 7.0) relative to surgeries that were performed for 10 or more years (long-term, PR 3.6, 95% CI: 2.0, 5.3). In this nationally representative sample of US adults, respondents who received bariatric surgery achieved substantial and significant weight loss compared with those who were eligible and did not receive bariatric surgery. Weight loss appeared to be most apparent in the short term and persisted over the long term.

Laparoscopic Sleeve Gastrectomy Then and Now: An Updated Systematic Review of the Progress and Short-term Outcomes Over the Last 5 Years

INTRODUCTION AND AIM

Laparoscopic sleeve gastrectomy (LSG) is considered one of the most popular bariatric surgeries of the present time. This review aimed to evaluate the progress and short-term outcomes of LSG over the last 5 years.

METHODS

The systematic review of electronic databases revealed 27 relevant articles, which were carefully assessed. The data extracted from the studies were analyzed and compared with data reported by a previous review published in 2010.

RESULTS

A total of 5218 patients were included in this review with a mean age of 41.1. The average preoperative body mass index (43.8±8) significantly dropped at 12 months to 30.7±3.9. The average percentage of excess weight loss at 1 year was 67.3. The mean rates of remission of diabetes mellitus, hypertension, and dyslipidemia were 81.9%, 66.5%, and 64.1%, respectively. The mean complication rate across the studies was 8.7% and the average mortality rate was 0.3%. A significant drop in postoperative body mass index, higher percentage of excess weight loss, and significantly lower overall complication rate were observed in comparison with the previous systematic review.

CONCLUSIONS

LSG continues to achieve satisfactory weight loss and improvement of obesity-related comorbidities with acceptably low morbidity and mortality rates.

Management of obesity in patients with type 2 diabetes mellitus in primary care

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.

Engineering of a Novel Simplified Human Insulin-Like Peptide 5 Agonist

Insulin-like peptide 5 (INSL5) has recently been discovered as only the second orexigenic gut hormone after ghrelin. As we have previously reported, INSL5 is extremely difficult to assemble and oxidize into its two-chain three-disulfide structure. The focus of this study was to generate structure-activity relationships (SARs) of INSL5 and use it to develop a potent and simpler INSL5 mimetic with RXFP4 agonist activity. A series of human and mouse INSL5 (hINSL5/mINSL5) analogues were designed and chemically synthesized, resulting in a chimeric INSL5 analogue exhibiting more than 10-fold higher potency (0.35 nM) at human RXFP4 compared with native hINSL5 (4.57 nM). The SAR study also identified a key residue (K(A15)) in the A-chain of mINSL5 that contributes to improved RXFP4 affinity and potency of mINSL5 compared with hINSL5. This knowledge ultimately led us to engineer a minimized hINSL5 mimetic agonist that retains native hINSL5-like RXFP4 affinity and potency at human RXFP4. This minimized analogue was synthesized in 17.5-fold higher yield and in less time compared with hINSL5.

Combination of very low energy diets and pharmacotherapy in the treatment of obesity: meta-analysis of published data

Obesity has reached epidemic proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - and is a major contributor to the global burden of chronic disease (heart disease and diabetes) and disability. The aim of the study was to perform a systematic review and meta-analysis of published data on the combination of very low energy diets also known as very low calorie diets and pharmacotherapy for its effectiveness in the treatment of obesity. A MEDLINE (Pubmed) search from 1970 to 2009 using multiple combinations of the relevant terms was carried out; the matching articles were also searched for additional references. Meta-analysis tools were used to summarize results. Only randomized controlled trials that compared pharmacotherapy with placebo after a very low energy diet period were selected, and six articles were finally considered to be appropriate for evaluation. The combination of very low energy diet and pharmacotherapy was found to be effective for people with obesity in clinical trials. The net effect of 6.1 kg placebo subtracted weight loss after 1 year represents a clinically meaningful result that is comparable with the effect of drugs given at the start of a weight loss programme. The present meta-analysis contributes to the understanding that combination therapies are expected to achieve greater weight loss than monotherapy; grasping this understanding, researcher has introduced newer anti-obesity pharmacological approaches have embraced combination therapies.

Reducing the risk of obesity: defining the role of weight loss drugs

The prevalence of obesity has increased dramatically in the past 20 years. As a public health concern, obesity is associated with a health care resource burden that is quickly approaching that associated with tobacco use. Although lifestyle intervention (diet and exercise) remains the mainstay of treatment of obesity, its effectiveness is limited by poor long-term adherence. Drug therapy has historically been unsuccessful in producing sustained weight loss. Many older weight loss drugs have adverse benefit-to-risk profiles. This review provides an overview of nonpharmacologic interventions for weight loss. The safety and efficacy of older weight loss drugs, as well as current data related to lorcaserin, phentermine/topiramate, and naltrexone-bupropion, are evaluated. Although associated with modest weight loss and some improvement in adverse obesity-related metabolic effects, none of these drugs has been demonstrated to reduce mortality. In addition, the long-term safety of these drugs remains largely unknown. Bariatric surgery is an option for patients with morbid obesity who have failed conventional treatment.