OBESITY AND DIABETES MELLITUS
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Keywords:
Orlistat
Sibutramine
Management of obesity
Weight management
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.
Sibutramine
Orlistat
Management of obesity
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Anti obesity
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Orlistat
Sibutramine
Management of obesity
Pharmacotherapy
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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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In his article on the use of medication in the management of obesity, Dr Sharma states that “there is now abundant evidence from pharmacologic trials that drugs such as orlistat, sibutramine, and rimonabant (a newer compound), when added to lifestyle interventions, can help patients maintain
Orlistat
Sibutramine
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Management of obesity
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Obesity is a major global health problem. However, current therapeutic strategies for obesity are limited. Obesity results from an imbalance between energy intake and energy expenditure, and the treatment of obesity is based on the correction of this metabolic imbalance. Anti-obesity drugs can shift this balance in a favorable way by reducing food intake, altering metabolism, and by increasing energy expenditure. There is a growing consensus that pharmacotherapy is appropriate for many individuals who are unable to lose weight through less intensive measures. However, side effects may ensue phamacotherapy for obesity. Only two drugs (sibutramine and orlistat) are currently approved for the long-term treatment of obesity. Sibutramine inhibits the reuptake of serotonin and norepinephrine. Orlistat works by blocking the pancreatic lipase. However, phamarcotherapy may not be the ultimate resolution for obesity management. Because the underlying pathophysiology in each individual varies in many aspects, it is recommended to provide individualized and tailored medication in addition to other anti-obesity supportive treatments.
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Sibutramine
Management of obesity
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Obesity is a major chronic health problem in adults. It is a complex, multifactorial disorder characterised by excess accumulation of adipose tissue. It is associated with a number of complications including cardiovascular disease, hypertension, type 2 diabetes, dyslipidaemia and cancer. A weight loss in the order of 5-10% is associated with clinically meaningful reductions with respect to all comorbidities. Diet and exercise has been the cornerstone of weight management therapy, but this approach has limitations, especially for weight maintenance. Previous drugs used in obesity had serious side effects including valvular heart disease. However, recent drugs like orlistat and sibutramine have been rigorously tested and proven safe. Orlistat, a lipase inhibitor, inhibits absorption of dietary fat by approximately 30%. Taken with a hypocaloric diet, it produces and maintains clinically meaningful weight loss. Sibutramine is a centrally-acting agent which enhances satiety and thermogenesis by inhibiting serotonin and noradrenaline re-uptake. It is appropriate for patients who are unable to lose weight by lifestyle modification.
Orlistat
Sibutramine
Management of obesity
Weight management
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Obesity is a major chronic health problem in adults. It is a complex, multifactorial disorder characterised by excess accumulation of adipose tissue. It is associated with a number of complications including cardiovascular disease, hypertension, type 2 diabetes, dyslipidaemia and cancer. A weight loss in the order of 5 – 10% is associated with clinically meaningful reductions with respect to all comorbidities. Diet and exercise has been the cornerstone of weight management therapy, but this approach has limitations, especially for weight maintenance. Previous drugs used in obesity had serious side effects including valvular heart disease. However, recent drugs like orlistat and sibutramine have been rigorously tested and proven safe. Orlistat, a lipase inhibitor, inhibits absorption of dietary fat by ∼ 30%. Taken with a hypocaloric diet, it produces and maintains clinically meaningful weight loss. Sibutramine is a centrally-acting agent which enhances satiety and thermogenesis by inhibiting serotonin and noradrenaline re-uptake. It is appropriate for patients who are unable to lose weight by lifestyle modification.
Orlistat
Sibutramine
Management of obesity
Weight management
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Sibutramine
Orlistat
Management of obesity
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Obesity is a chronic disease requiring a similar long term approach to management as that of other chronic conditions.This article discusses the role of medications in the overall management of obesity.Management needs to be multifaceted, aiming to alter the patient and family micro-environment to one favouring better weight control through sustainable behavioural changes to physical activity and diet. Weight loss medications may provide additional benefit. Currently we have only two medications suitable for long term therapy--orlistat and sibutramine. Sibutramine, which acts centrally to suppress appetite, has shown efficacy for up to 2 years. Orlistat, a lipase inhibitor, reduces fat absorption and has been shown to reduce and maintain weight for up to 4 years. The effect of these medications is modest, generally providing less than 5 kg weight loss when compared with placebo. Patients need to have realistic expectations and understand the benefits of sustained modest weight loss. It is important that weight loss medications are prescribed in combination with lifestyle modification.
Orlistat
Sibutramine
Management of obesity
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