Modern Medical Management of Obesity: The Role of Pharmaceutical Intervention

摘要: Abstract The medical model of obesity treatment—combining diet, exercise, and behavior modification with antiobesity agents—suffered a setback when fenfluramine dexfenfluramine were withdrawn from the market because an association between these medications valvular regurgitation. Food Drug Administration has recently approved sibutramine (Meridia), norepinephrine serotonin reuptake inhibitor that was originally developed as antidepressant, but which also been shown to reduce weight. In 1-year placebo-controlled trial, 65% patients receiving 15mg daily lost more than 5% their body weight, compared 29% placebo; 39% in group 10% 8% placebo group. Health benefits observed include reductions levels triglycerides, uric acid, total cholesterol, low-density lipoprotein (LDL) cholesterol increase high-density (HDL) levels. Another drug currently under review by is orlistat (Xenical), pancreatic lipase reduces absorption dietary fat approximately 30%, thus reducing energy intake. 55% 25% 33% 15%, respectively, addition, slowed rate weight regain second year treatment. demonstrated clinical trials reduced LDL increased HDL blood pressure fasting insulin levels, improved oral glucose tolerance test outcomes, glycemic control obese diabetes. future pharmacologic treatment promising. Many new agents are early stages development, our understanding body's weight-regulating mechanisms advancing steadily. Human recombinant leptin underway. Other promising compounds those block Neuropeptide Y5 Y1 (NY5, NY1) Melanocortin-4 (MC4) receptors, stimulate uncoupling proteins, unbind corticotrophin-releasing factor its binding protein. As better treatments for become available, focus prescription may shift away intake toward healthier eating disease prevention. At present, comprehensive approach, which, some patients, therapy adjunct, necessary treat effectively. J Am Diet Assoc. 1998;98(suppl 2):S23–S26 .