Safety, Efficacy and Ethical Issues Regarding Weight-Loss Medications

Michael William Lee

Disclosures

Expert Rev Clin Pharmacol. 2009;2(2):111-113. 

In This Article

Ethical Issues

Assuming that future obesity treatments meet reasonable levels of efficacy and safety, societal consideration must then be given to the equitable distribution of such pharmacologic therapies. Given the worldwide obesity epidemic, which patient populations would receive the most benefit from the finite treatments available?

For additional guidance, one could look at the risk-assessment tools used in the evaluation of cardiovascular disease and osteoporosis. The American Framingham risk score incorporates age, gender, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, diabetes and smoking to derive an estimated risk of developing coronary heart disease within 10 years (in Europe, the SCORE model serves a similar purpose).[3] In 2008, a WHO task force introduced the Fracture Risk Assessment Tool (FRAX®), which estimates the 10-year probability of fracture based on clinical risk factors and the bone mineral density at the femoral neck.[105] Both the Framingham Risk Score and FRAX have subsequently been used to determine intervention thresholds for statin and bisphosphonate therapy, respectively.

Clinical tools, such as BMI calculation and the diagnosis of metabolic syndrome, do identify those at risk for cardiovascular disease and Type 2 diabetes, but may lack precise long-term predictive value. While a new obesity risk-assessment tool might include components of metabolic syndrome (e.g., waist circumference and blood lipid values), it should aim to provide 10-year probabilities of developing specific obesity-related end points. If such a risk model could be developed and was comparable in accuracy to Framingham and FRAX, then cost-effective and country-specific criteria for the pharmacologic treatment of obesity could be established.

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