A contemporary view on obesity treatment in adults

Literature review

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.61.45-50

Keywords:

overweight, obesity, body mass index, liraglutide, naltrexone, bupropion, orlistat

Abstract

Today, the prevalence of overweight and obesity is pandemic. This disorder is defined as “a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications, and decreases life expectancy”.
This article presents evidence-based clinical guidelines for the management of obese patients, as well as excerpts comments on pharmacological treatment.
Treatment approaches for overweight and obese patients include behavioral interventions, lifestyle adjustments, etc. One of the methods is pharmacological therapy, based on the following principles: therapy for weight loss can be used starting already at a body mass index ≥ 27 kg/m2 or ≥ 30 kg/m2 with complications associated with excess body fat. As drugs can be used liraglutide, combination of naltrexone + bupropion, orlistat. Pharmacotherapy must be accompanied by lifestyle modification, including if necessary therapeutic diet, increased physical activity on ongoing basis with its mandatory control, and behavioral or cognitive-behavioral therapy. Pharmacotherapy can be used to support the weight loss achieved through lifestyle modifications and to prevent weight gain. It is forbidden to use over-the-counter drugs unless they are approved for weight control. Patients with metabolic obesity should be consulted by specialists to assess the feasibility of bariatric surgery, followed by treatment with this specialist.
Every clinician must have sufficient knowledge to diagnose obesity and offer their patients an individualized, long-term, evidence-based weight loss regimen. The success of obesity treatment depends on the patient's trust the doctor and on the doctor's knowledge in this area.

Author Biographies

V.I. Velychko, Odesa National Medical University, Odesa

MD, professor, head of the Department of Family Medicine, chairman of the Association of Family Medicine of the Odesa Region

B.M. Mankovskyi, P.L. Shupyk National University of Health of Ukraine, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, head of the Department of Diabetology

T.F. Tatarchuk, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, head of the Endocrine Gynecology Department;
Chief researcher, Department of Reproductive Health

D.O. Lahoda, Odesa National Medical University, Odesa

Assistant, Department of Family Medicine

I.M. Todurov, State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

MD, professor, director

O.M. Lishchyshyna, State Scientific Institution “Scientific and Practical Center for Preventive and Clinical Medicine” of the State Management of Affairs, Kyiv

PhD, senior researcher, head of the Scientific Department of Medical Care Organization

References

  1. le Roux, C.W., Astrup, A., Fujioka, K., et al. “3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double- blind trial.” Lancet 389.10077 (2017): 1399–1409. DOI: 10.1016/S0140-6736(17)30069-7
  2. Pi-Sunyer, X., Astrup, A., Fujioka, K., et al. “A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management.” The New England Journal of Medicine 373.1 (2015): 11–22. DOI: 10.1056/NEJMoa1411892
  3. American Medical Association. “AMA Adopts New Policies on Second Day of Voting at Annual Meeting.” (2013) [cited 2014 Apr 7]. Available from: [http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page].
  4. Kim, S.Y., Yoo, D.M., Min, C., et al. “Analysis of Mortality and Morbidity in COVID-19 Patients with Obesity Using Clinical Epidemiological Data from the Korean Center for Disease Control & Prevention.” Int J Environ Res Public Health 17.24 (2020): 9336. DOI: 10.3390/ijerph17249336
  5. Carter, R., Moodie, M., Markwick, A., et al. “Assessing Cost-Effectiveness in Obesity (ACE-Obesity): an overview of the ACE approach, economic methods and cost results.”BMC Public Health 9.419 (2009). Available from: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-419#Sec23].
  6. Smith, S., Fujioka, K., Gupta, A., et al. “Combination therapy with naltrexone and bupropion for obesity reduces total and visceral adiposity.” Diabetes Obes Metab 15.9 (2013): 863–866. DOI: 10.1111/dom.12095
  7. Promrat, K., Kleiner, D.E., Niemeier, H.M., et al. “Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis.” Hepatology 51.1 (2010): 121–9. DOI: 10.1002/hep.23276
  8. Turpeinen, M., Tolonen, A., Uusitalo, J., et al. “Effect of clopidogrel and ticlopidine on cytochrome P450 2B6 activity as measured by bupropion hydroxylation.” Clinical Pharmacology & Therapeutics 77.6 (2005): 553–9. DOI: 10.1016/j.clpt.2005.02.010
  9. Greenway, F.L., Fujioka, K., Plodkowski, R.A., et al. “Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.” Lancet 376.9741 (2010): 595–605. DOI: 10.1016/S0140-6736(10)60888-4
  10. Richelsen, B., Tonstad, S., Rossner, S., et al. “Effect of Orlistat on Weight Regain and Cardiovascular Risk Factors Following a Very-Low-Energy Diet in Abdominally Obese Patients: a 3-year randomized, placebo-controlled study.” Diabetes Care 30.1 (2007): 27–32. DOI: 10.2337/dc06-0210.
  11. Rosenstock, J., Klaff, L., Schwarts, S., et al. “Effects of exenatide and lifestyle modification on body weight and glucose tolerance in obese subjects with and without pre-diabetes.” Diabetes Care 33.6 (2010): 1173–5. DOI: 10.2337/dc09-1203
  12. Hollander, P., Gupta, A., Plodkowski, R., et al. “Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes.” Diabetes Care 36.12 (2013): 4022–9. DOI: 10.2337/dc13-0234
  13. Davies, M.J., Bergenstal, R., Bode, B., et al. “Efficacy of Liraglutide for Weight Loss Among Patients with Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial.” JAMA 314.7 (2015): 687–99. DOI: 10.1001/jama.2015.9676
  14. U.S. Food and Drug Administration. “FDA approves weight management drug for patients aged 12 and older.” Available from: [https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-weight-management-drug-patients-aged-12-and-older].
  15. Kelly, T., Yang, W., Chen, C-S., et al. “Global burden of obesity in 2005 and projections to 2030.” Int J Obes 32.9 (2008): 1431–7. DOI: 10.1038/ijo.2008.102
  16. Ng, M., Fleming, T., Robinson, M., et al. “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013.” Lancet 384.9945 (2014): 766–81. 10.1016/S0140-6736(14)60460-8
  17. Nalpropion Pharmaceuticals LLC. CONTRAVE: prescribing information. Available from: [https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=485ff360-32c8-11df-928b-0002a5d5c51b&type=display].
  18. Hu, F.B. Obesity epidemiology. New York: Oxford University Press (2008): 498 p.
  19. Jelsing, J., Vrang, N., Hansen, G., et al. “Liraglutide: short-lived effect on gastric emptying – long lasting effects on body weight.” Diabetes Obes Metab 14.6 (2012): 1–8. DOI: 10.1111/j.1463-1326.2012.01557.x
  20. Wilson, N., Shah, N., Manitpisitkul, W., et al. “Liver Failure Requiring Transplantation After Orlistat Use.” Pharmacotherapy 31.11 (2011): 1145. DOI: 10.1592/phco.31.11.1145
  21. Rucker, D., Padwal, R., Li, S.K., et al. “Long term pharmacotherapy for obesity and overweight: updated meta- analysis.” BMJ 335.7631 (2007): 1194–9. DOI: 10.1136/bmj.39385.413113.25
  22. Padwal, R., Kezouh, A., Levine, M., Etminan, M. “Long-term persistence with orlistat and sibutramine in a population-based cohort.” Int J Obes 31.10 (2007): 1567–70. DOI: 10.1038/sj.ijo.0803631
  23. Mcneely, W., Benfield, P. “Orlistat.” Drugs 56.2 (1998): 241–9. DOI: 10.2165/00003495-199856020-00007
  24. Nainggolan, L. “Call to Action on Obesity Amidst COVID-19 Pandemic.” Available from: [https://www.medscape.com/viewarticle/946890].
  25. Stevens, G.A., Singh, G.M., Lu, Y., et al. “National, regional, and global trends in adult overweight and obesity prevalences.” Population Health Metrics 10.1 (2012): 22. DOI: 10.1186/1478-7954-10-22
  26. Poly, T.N., Islam, M.M., Yang, H.C., et al. “Obesity and Mortality Among Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis.” Frontiers in Medicine 8 (2021): 620044. DOI: 10.3389/fmed.2021.620044
  27. Jacob, S., Rabbia, M., Meier, M.K., Hauptman, J. “Orlistat 120 mg improves glycaemic control in type 2 diabetic patients with or without concurrenweight loss.” Diabetes Obes Metab 11.4 (2009): 361–71. DOI: 10.1111/j.1463-1326.2008.00970.x
  28. Weir, M.A., Beyea, M.M., Gomes, T., et al. “Orlistat and acute kidney injury: An analysis of 953 Patients.” Arch Intern Med 171.7 (2011): 703–4. DOI: 10.1001/archinternmed.2011.103
  29. Product Monograph. “SAXENDA®.” Available from: [https://www.novonordisk.ca/content/dam/Canada/AFFILIATE/www-novonordisk-ca/OurProducts/PDF/Saxenda_PM_ English.pdf].
  30. Product Monograph. “CONTRAVE® (Naltrexone hydrochloride 8 mg and Bupropion hydrochloride 90 mg).” Available from: [https://pdf.hres.ca/dpd_pm/00043849.PDF].
  31. Product Monograph. “XENICAL®.” Available from: [https://rochecanada.com/PMs/Xenical/Xenical_PM_E.pdf].
  32. Greenway, F.L., Whitehouse, M.J., Guttadauria, M., et al. “Rational Design of a Combination Medication for the Treatment of Obesity.” Obesity (Silver Spring) 17.1 (2009): 30–9. DOI: 10.1038/oby.2008.461
  33. Russell, P. “Doctors in England to Be Offered Incentives to Help People Lose Weight.” Available from: [https://www.medscape.com/viewarticle/934609].
  34. ClinicalTrials.gov. “STEP 1: Research Study Investigating How Well Semaglutide Works in People Suffering From Overweight or Obesity (STEP 1).” Available from: [https://www.clinicaltrials.gov/ct2/show/NCT03548935].
  35. Secher, A., Jelsing, J., Baquero, A.F., et al. “The arcuate nucleus mediates GLP-1 receptor agonist liraglutide-dependent weight loss.” J Clin Invest 124.10 (2014): 4473–88. DOI: 10.1172/JCI75276
  36. Bjornsson, T.D., Callaghan, J.T., Einolf, H.J., et al. “The conduct of in vitro and in vivo drug-drug interaction studies: A PhRMA Perspective.” J Clin Pharmacol 43.5 (2003): 443–69. DOI: 10.1177/0091270003252519
  37. von Ruesten, A., Steffen, A., Floegel, A., et al. “Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015.” PloS One 6.11 (2011): e27455. DOI: 10.1371/journal.pone.0027455
  38. Wadden, T.A., Hollander, P., Klein, S., et al. “Weight maintenance and additional weight loss with liraglutide after low- calorie-diet-induced weight loss: The SCALE Maintenance randomized study.” Int J Obes 37.11 (2013): 1443–51. DOI: 10.1038/ijo.2013.120
  39. Wang, Y., Beydoun, M.A., Liang, L., et al. “Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic.” Obesity (Silver Spring) 16.10 (2008): 2323–30. DOI: 10.1038/oby.2008.351
  40. World Health Organization. “Controlling the global obesity epidemic.” Available from: [https://www.who.int/activities/controlling-the-global-obesity-epidemic].
  41. Torgerson, J., Hauptman, J., Boldrin, M., Sjöström, L. “XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.” Diabetes Care 27.1 (2004): 155–61.
  42. Tatarchuk, T.F. “Management of menopause: modern trends.” Reproductive Endocrinology 46 (2019): 19–24.

Published

2021-11-25

How to Cite

Velychko, V., Mankovskyi, B., Tatarchuk, T., Lahoda, D., Todurov, I., & Lishchyshyna, O. (2021). A contemporary view on obesity treatment in adults: Literature review. REPRODUCTIVE ENDOCRINOLOGY, (61), 45–50. https://doi.org/10.18370/2309-4117.2021.61.45-50

Issue

Section

Endocrinology

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