Pharmacological treatment of obesity in children and adolescents: current status and perspectives
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Importance of the field: The prevalence of overweight and obesity in children and adolescents is increasing rapidly, while the short- and long-term morbid outcomes make these entities a major public health concern. Initial steps in therapy are based on dietary and lifestyle intervention. In the presence of an insufficient progress, medication or – eventually – surgery may be recommended. Three drugs are currently used: orlistat, metformin, and sibutramine; other candidates are in development. However, trials assessing the efficacy and safety of the current medications are frequently affected by methodological limitations, in particular insufficient power and period of follow-up. Areas covered in this review: The efficacy and safety of antiobesity drugs currently used for children and adolescents are reviewed. Additional information on upcoming agents is presented. What the reader will gain: This is an exhaustive review of current state on controversial issues regarding drugs used in children and adolescent obesity, specifically related with their efficacy and safety. Take home message: The efficacy of these drugs is modest. Our knowledge of their efficacy and safety comes from clinical trials affected by insufficient follow-up (1 year or less); very often, these trials are of limited power. Further data from larger and longer well-designed clinical trials would be advisable.Keywords:
Orlistat
Sibutramine
The increase in obesity prevalence is problematic as this condition is associated with health complications such as diabetes and cardiovascular diseases, more particularly when the excess body fat is stored in the deep abdominal region. The mainstay of therapy consists of behavior modification related to obesity such as overeating and physical inactivity. When these lifestyle modifying attempts fail, the use of anti-obesity drugs is warranted. Drug treatment is often indicated but is somewhat limited by the minimal number of well tolerated drugs that have proven to have long-term efficacy in maintaining body weight loss. The currently available drugs, sibutramine and orlistat, appear modestly effective in promoting weight loss. Ongoing studies continue to evaluate other drug treatments that may result in body weight reduction through a number of different mechanisms. Thus, the aim of this review is to present an overview of the current drugs available (particularly sibutramine and orlistat) as well as potential future candidates, and the impact of these agents on obesity and cardiovascular physiology. Furthermore, the therapeutic paradox of sibutramine in preventing obesity will be discussed as well as the beneficial impact of physical exercise on cardiac economy. Keywords: pharmacotherapy, overweight, sibutramine, orlistat, drugs, fat, heart rate, blood pressure
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The currently available drugs for long-term treatment of obesity are sibutramine and orlistat. They have been shown to be able to induce significant weight loss, with important co-morbidity reduction, allowing the maintenance of reduced body weight for at least 1-2 years. Cardiostimulating and gastrointestinal adverse effects are however not negligible.
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Introduction: Since obesity is the second leading cause of preventable death in the United States, effective treatments are crucial in order to stop the progression of this epidemic. Currently, orlistat (Xenical) and sibutramine (Meridia, Reductil) are the only FDA approved obesity drugs for long-term weight loss in adults. The aim of this study is to compare the effectiveness of these two drugs in initial weight loss as well as long-term maintenance of that weight loss. Methodology: An evidence-based systematic literature review was conducted using the following databases: Medline, ECO, and Cochrane. Articles chosen for inclusion were from 1990 to present, level 1 or 2 evidence and from peer-reviewed journals. Participants were over 18 years old with a BMI greater than 27 kg/m 2 . Results: There were 18 level 1 randomized controlled trials demonstrating the effectiveness of both medications to produce weight loss. Therefore, a Grade A recommendation can be made regarding the use of either orlistat or sibutramine in a primary care setting for 5-10% weight loss. Also, there were 10 level 1 randomized controlled trials demonstrating the management of the weight loss for up to 2 years, so a Grade A recommendation can be made regarding the use of either orlistat or sibutramine in the long-term management of weight loss. Conclusion: Both medications are effective for an obese patient who has failed on diet and exercise alone, so selection of which medication to prescribe is primarily determined on which medication the patient is most able to tolerate.
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AIM:To compare the efficacy and investigate the clinic value between sibutramine and orlistat for obesity.METHODS:The database was retrieved from PubMed,EMBASE,SCI,the Cochrane Library,Chinese Biomedical Literature Database,China Journal Full TextDatabase,Chinese Medical Association Journals,and references of the included studies up to December 2009.Randomized control trials (RCT) of sibutramine versus orlistat for obesity were included.The quality of the included studies was evaluated by Handbook recommend standard.Data were analyzed by RevMan 5.0 from the Cochrane Collaboration.RESULTS:Five RCTs were included.Meta-analysis showed that there were no differences between sibutramine and orlistat for obesity in weight loss,body mass index(BMI) decrease,waist circumference decrease and LDL-C change.Although there were fewer adverse events in the two groups,the form of adverse events were different because of the different mechanism of two drugs.CONCLUSION:Sibutramine and Orlistat have significant effects in the treatment of obesity.Meanwhile,there is no significant difference between two drugs,while the performance of two groups of drug adverse events is different.
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The long-term effects on weight have only been studied for orlistat and sibutramine. The net effects of these drugs vary between 2-5% loss of weight after 1-2 years of treatment. However, the effects of orlistat and sibutramine on morbidity and mortality have not been studied extensively. In the past decade a huge amount of new knowledge has been gathered on the physiology of energy metabolism, satiety, gut-brain interactions, adipokines, adipogenesis, hypothalamic regulation etc. These studies have provided a multitude of new pharmacological targets for the treatment of obesity. Preclinical and clinical studies will have to prove the efficacy and safety of new drugs aimed at these new targets. The ultimate goal will be to reduce the increased morbidity and mortality, associated with obesity. Keywords: Orlistat, sibutramine, obesity, hypothalamus, satiety, hormones
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TherapeuticsMarch 1, 2008Review: Orlistat, sibutramine, and rimonabant reduce weight in overweight and obese personsAlka M. Kanaya, MDAlka M. Kanaya, MDUniversity of California, San Francisco, San Francisco, California, USA (A.M.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2008-148-2-050 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationRucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335:1194-9. https://pubmed.ncbi.nlm.nih.gov/18006966Clinical Impact RatingsGIM/FP/GP: Endocrinology: References1 Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755-67. [PMID: 17904936] Google Scholar2 Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52. [PMID: 17715408] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, California, USA (A.M.K.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Current IssueMarch 1, 2008Volume 148, Issue 2Page: 50KeywordsAdverse eventsBlood pressureCholesterolConstipationDietDrugsEndocrinologyExerciseFactor analysisHealth care quality assessmentInformation storage and retrievalInsomniaLipoproteinsMedical risk factorsMorbidityMouthNauseaObesityOverweightWeight loss ePublished: 4 March 2020 Issue Published: March 1, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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Ancillary therapies for weight management, consisting mainly of diet and exercise programs that incorporate variable levels of lifestyle modification techniques, are frequently ineffective to achieve clinically meaningful weight loss and maintenance. Although pharmacological treatment of obesity is widely used in most countries, the number of available drugs is still very limited. The most widely used anti-obesity agents are sibutramine and orlistat, both available in clinical practice for about a decade. A large number of clinical trials have demonstrated that both agents are safe and well tolerated, with a level of efficacy in the moderate weight loss recommended by the most relevant clinical guidelines. Several studies have assessed the efficacy and safety of sibutramine and orlistat in adolescents and also for the treatment of some associated conditions in adults, including type 2 diabetes, polycystic ovary syndrome and binge eating disorder. The positive results of these studies suggest an expanding role for both agents, not only for the treatment of obesity, but also for associated conditions. After the efficacy of orlistat for the prevention of type 2 diabetes demonstrated in the XENDOS study, the results of SCOUT study are awaited for a better evaluation of sibutramine impact on cardiovascular outcomes.
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