COMMENTARY

Can We Medicate Our Way Out of the Obesity Epidemic?

Old Drugs, New Drugs

Charles P. Vega, MD

Disclosures

October 09, 2014

In This Article

Obesity—A King-Sized Problem?

Obesity is a tremendous health challenge that seems impossible to vanquish. The prevalence of obesity among US adults and children remains high, and diet and exercise alone are often ineffective at fixing the problem. Previous drug therapy for obesity has largely been ineffective, dangerous, or both. Today there are new products on the market that have demonstrated efficacy over at least 1 year of use. Nonetheless, questions about the safety of these agents remain. The current review highlights the state of the art in weight loss medications.

There has been much attention—and rightly so—paid to the obesity epidemic in the United States. We know that we have a problem. It is time to pay more attention to the solution, and that is difficult for many Americans to truly embrace. In episode 7 of season 7 of The Simpsons, you may recall that Homer Simpson decided to pursue hyperobesity beyond his usual stout physical status so that he could claim disability and work from home. The episode ends with Homer's epiphany that he needs to lose the weight, but he cannot perform even one sit-up under the coaching of his boss, C. Montgomery Burns.

"I'll just pay for the blasted liposuction!" says Mr. Burns.

"Woo hoo!" replies an exultant Homer.

America appears ready to say "Woo hoo!" to a host of medications designed to treat obesity. But are they effective and safe, or are we fated to become a nation of Homer Simpsons?

How Big Are We?

There is some good news from epidemiologic research regarding obesity in the United States. America's waistlines are not expanding at the rate they were a decade ago. Nonetheless, the estimated rates of obesity among adults and children/adolescents in 2011-2012 were 34.9% and 16.9%, respectively. The prevalence of obesity remained stable among adults and youth in comparing data from 2003-2004 with 2011-2012.[1]

The sheer magnitude of the obesity problem in the United States constitutes a public health crisis but also a fantastic marketing opportunity for the medical treatment of obesity. There are millions of US adults with obesity, and diet and exercise are not sufficient to treat the lot of us. Low-calorie or very-low-calorie diets do promote weight loss. In one review of randomized controlled trials, the mean weight loss associated with such diets was 12.3 kg.[2]

However, the health benefits of weight loss are only accrued over time, as chronic illnesses such as hypertension or type 2 diabetes are controlled or even prevented from occurring in the first place. And that is where the collective research on dietary changes falls down. While high-protein diets may promote a modest achievement in the maintenance of weight loss, exercise alone or dietary supplements do not.[2] This same analysis found that antiobesity drugs were substantially more effective than control treatment in preventing weight regain.

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