Highlights From the North American Society for the Study of Obesity Annual Meeting: A Physician's View

Raymond A. Plodkowski, MD


December 01, 2003

In This Article

Pharmacologic Therapy for Weight Loss

For obese patients (BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 if comorbidities exist) who have failed traditional methods of lifestyle modification with reduced caloric intake and increased physical activity, weight-loss medications are an option. It should be noted that weight-loss medications should only be used for limited amounts of time. Furthermore, if proper nutrition and exercise habits are not in place, the vast majority of patients will regain weight after discontinuing the medication. In addition to 2 popular drugs that have been approved by the US Food and Drug Administration (FDA) -- sibutramine[29] and orlistat[30] -- new evidence is emerging regarding other medications that cause weight loss.

There was much excitement expressed and several studies presented at NAASO that explored topiramate as a possible weight-loss medication. Topiramate is a drug approved by the FDA as an anticonvulsant for seizure disorders; however, it also appears to induce weight loss. One study examined the effects of topiramate on body fat after a low-calorie diet induced weight loss.[31] Obese subjects (BMI ≥ 30 and ≤ 50 kg/m2) who lost 8% of their weight after 8 weeks of 800-1000 kcal/day diet were randomized to receive placebo, 96 mg topiramate daily, or 192 mg topiramate daily. After 32 weeks, the changes in body weight in the placebo, 96-mg, and 192-mg groups were -11.2%, -16.3% (P ≤ .001), and -17.3% (P ≤ .001), respectively. The patients also had visceral abdominal fat (VAF) measured by MRI, and after 32 weeks, the changes in VAF in the placebo, 96-mg, and 192-mg groups were -27.1%, -36.7% (P ≤ .001), and -34.7% (P ≤ .001), respectively. The most common CNS-related adverse events were paresthesia, fatigue, dizziness, memory difficulty, concentration difficulty, and depression. The manufacturer is currently developing a formulation to enhance tolerability.


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