Is cardiometabolic risk improved by weight-loss drugs?

Effect of soybean milk fermented with Lactobacillus plantarum HFY01 isolated from yak yogurt on weight loss and lipid reduction in mice with obesity induced by a high-fat diet

Soybean milk fermented with Lactobacillus plantarum HFY01 (LP-HFY01) was used for weight and lipid reduction in mice with obesity induced by a high-fat diet. We evaluated the gastrointestinal tolerance in vitro, organ index, body fat rate, pathological changes, serum index, mRNA expression and changes of isoflavones in soybean milk. Results indicated that LP-HFY01 exhibited good tolerance to pH 3.0 artificial gastric juice (69.87 ± 0.04%) and 0.3% bile salt (15.94 ± 0.3%). LP-HFY01-fermented soybean milk reduced the body fat rate and liver index of obese mice (p < 0.05). Organ sections showed that LP-HFY01-fermented soybean milk improved fatty degeneration and liver cell damage caused by a high-fat diet. LP-HFY01-fermented soybean milk inhibited increases in low-density lipoprotein cholesterol (LDL-c), triglyceride (TG), alkaline phosphatase (AKP), and glutamic oxaloacetic transaminase (GOT) and the decrease in high-density lipoprotein cholesterol (HDL-c) in the serum of obese mice, and inhibited CCAAT/enhancer-binding protein-α (C/EBP-α) and peroxisome proliferator-activated receptor-γ (PPAR-γ) mRNA expression, as well as activated cuprozinc-superoxide dismutase (SOD1) and lipoprotein lipase (LPL) mRNA expression in the liver and epididymal fat of obese mice (p < 0.05). Daidzin, glycitin, daidzein, glycitein, genistein, and genistin contents in soybean milk were determined before and after fermentation by high-performance liquid chromatography (HPLC); the daidzin and genistin contents in the fermented soybean milk decreased, whereas the daidzein and genistein contents increased significantly. Therefore, the LP-HFY01-fermented soybean milk strongly inhibits obesity induced by a high-fat diet, and shows good potential for utilization.

Current Options for the Pharmacotherapy of Obesity

650 millions of adults are obese worldwide - in the US alone, forty percent of the adults are obese. Although the obesity pandemic is constantly expanding at very high costs for health care systems, the currently available options of pharmacotherapy for obesity are rather limited. Despite intensive research efforts, the vast majority of the anti-obesity drugs developed up to now have a rather limited efficacy and/or safety profile. In the last fifty years, various drugs reached advanced states of clinical development but were either never marketed or were initially approved but withdrawn later due to safety issues. However, the understanding of the pathophysiology of obesity has been steadily improving and new, promising drugs targeting various selective obesityassociated and energy-homeostasis-related pathways are now available. When lifestyle changes alone fail to combat, then additional pharmacotherapy with an acceptable efficacy and safety profile could provide a useful therapeutic option.

Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to date

Obesity is an emerging disease worldwide. Changes in living habits, especially with increased consumption of high-calorie foods and decreased levels of physical activity, lead to an energy imbalance that brings weight gain. Overweight and obesity are major risk factors for several chronic diseases (including cardiovascular diseases, diabetes, and cancer), reduce quality of life, and are associated with higher mortality. For all these reasons, it is of the utmost importance that the trend be reversed and obese people enabled to lose weight. It is known that eating a healthy diet and exercising regularly can help prevent obesity, but data show that in many cases these steps are not enough. This is the reason why, over the last few decades, several antiobesity drugs have been developed. However, the disappointing results demonstrated for the vast majority of them have not discouraged the pharmaceutical industry from continuing to look for an effective drug or combination of drugs. The systematic review presented here focuses on naltrexone sustained-release/bupropion sustained-release combination (Contrave^®). We conclude from the current published reports that its effectiveness in the treatment of obesity can be estimated as a placebo-subtracted weight loss of around 4.5%. This weight reduction is moderate but similar to other antiobesity drugs. The safety profile of this combination is acceptable, despite additional data regarding cardiovascular disease being needed.

Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide

Objective:

Having demonstrated short-term weight loss with liraglutide in this group of obese adults, we now evaluate safety/tolerability (primary outcome) and long-term efficacy for sustaining weight loss (secondary outcome) over 2 years.

Design:

A randomized, double-blind, placebo-controlled 20-week study with 2-year extension (sponsor unblinded at 20 weeks, participants/investigators at 1 year) in 19 European clinical research centers.

Subjects:

A total of 564 adults (n=90–98 per group; body mass index 30–40 kg m⁻²) enrolled, 398 entered the extension and 268 completed the 2-year trial. Participants received diet (500 kcal deficit per day) and exercise counseling during 2-week run-in, before being randomly assigned (with a telephone or web-based system) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg, n=90–95), placebo (n=98) or open-label orlistat (120 mg × 3, n=95). After 1 year, liraglutide/placebo recipients switched to liraglutide 2.4 mg, then 3.0 mg (based on 20-week and 1-year results, respectively). The trial ran from January 2007–April 2009 and is registered with Clinicaltrials.gov, number NCT00480909.

Results:

From randomization to year 1, liraglutide 3.0 mg recipients lost 5.8 kg (95% confidence interval 3.7–8.0) more weight than those on placebo and 3.8 kg (1.6–6.0) more than those on orlistat (P⩽0.0001; intention-to-treat, last-observation-carried-forward). At year 2, participants on liraglutide 2.4/3.0 mg for the full 2 years (pooled group, n=184) lost 3.0 kg (1.3–4.7) more weight than those on orlistat (n=95; P<0.001). Completers on liraglutide 2.4/3.0 mg (n=92) maintained a 2-year weight loss of 7.8 kg from screening. With liraglutide 3.0 mg, 20-week body fat decreased by 15.4% and lean tissue by 2.0%. The most frequent drug-related side effects were mild to moderate, transient nausea and vomiting. With liraglutide 2.4/3.0 mg, the 2-year prevalence of prediabetes and metabolic syndrome decreased by 52 and 59%, with improvements in blood pressure and lipids.

Conclusion:

Liraglutide is well tolerated, sustains weight loss over 2 years and improves cardiovascular risk factors.

Well-being of obese individuals: therapeutic perspectives

The history of pharmacologic treatment of obesity is characterized by too much focus on efficacy and too little on safety, which has led to withdrawals of drugs from the market after serious adverse events. The development of new drug targets for the management of obesity will definitively need to address effects of the CNS and overall cardiovascular safety in the early stages in order to avoid the mistakes from the past. For instance, weight loss can increase the symptoms of depression and promote a state of psychobiological vulnerability favoring weight regain. Body-weight management should then seek a balance between the health benefits of weight loss and its potential risks, a ‘zone’ that is associated with an optimal psychobiological well-being.