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Pharmacological obesity treatment – for whom and how?

Obesity treatment is determined by the body’s fat content. In practice, indicators such as BMI are used for diagnostic purposes. A BMI value above 30 kg / m2 is considered obese.

The causes of obesity in society are complex, resulting from the relationship between genetics, socioeconomic and cultural factors. Nutritional culture and the widely understood lifestyle strongly affect the risk of obesity, potentially dangerous to health.

Obesity treatment

Who is the lifestyle change for? Who is the drug for?

The basic principle of obesity treatment is to inform the patient, potentially interested in treatment, about the risk of a lack of intervention and the methods of intervention. The possibility of making a choice and making conscious steps towards health are the foundations for an effective fight against obesity.

Changing the lifestyle, understood as eating a high-quality diet, adequate physical activity and other daily habits, is an absolute foundation in the process of fighting obesity.

Consideration of pharmacological intervention in weight loss may be considered when the BMI is greater than 30 kg / m2. The use of drugs in the case of less developed obesity is justified when there are health complications related to obesity.

Treatment of obesity with drugs is additional to lifestyle changes.

Maintaining a healthy body weight reduces problems related to high blood pressure, diabetes and cardiovascular diseases. Medications to help you lose excess weight, however, are not a standalone solution to obesity and related diseases. They are always used as an additive to help achieve optimal weight.

What medications are used to reduce weight?

Medicines used to reduce body weight should be used under medical supervision. Each of these substances has different side effects, especially when drugs are taken uncontrolled, unconsciously, without clearly defined goals and doses.

Phentermine

Phenamine is an appetite suppressant. The substance is effective in reducing body weight, however, numerous side effects make access to pheteramine very limited. It is not available in most European countries, including Poland. The drug should not be used especially by people who have cardiovascular diseases.

Orlistat

Orlistat works by inhibiting the release of enzymes responsible for the digestion of fats. Using a dose of 120 mg 3 times a day with a meal reduces fat absorption by about 30%. A substance is considered to be relatively safe when used as recommended. When using orlistat, remember to follow a diet rich in fat-soluble vitamins (A, D, E, K). Eating a sufficiently large dose of vegetables may be enough, or you should consult your doctor about supplementation.

The side effects of using orlistat are primarily: deficiencies of fat-soluble vitamins, flatulence, fatty stools and an increased risk of kidney stones.

Liraglutide

Liraglutide is an analog of the gut hormones released when food is consumed. Used primarily as an antidiabetic drug, it is used as a drug supporting the fight against obesity. Its side effect, the main one is supporting the work of the pancreas, is reducing appetite, which allows you to reduce body weight. Liraglutide is a good choice to help reduce body weight in a diabetic patient. It is a safe drug in case of high cardiovascular risk.

Undesirable side effects of liraglutide use include vomiting, constipation, and an increased risk of nephrolithiasis and pancreatitis.

Mysimba (bupropion + nalterkson)

The combination of an opioid receptor inhibitor with an antidepressant drug has an effect supporting weight loss. The mechanism of action of the drug is not fully understood, but this drug is accepted by scientific societies due to its effectiveness. Treatment with the preparation should be strictly controlled by a doctor, it is not recommended to use the drug in renal or hepatic insufficiency.

When to stop therapy?

The use of weight loss medication should be closely monitored during the first 3 months (4 for liraglutide). Treatment must be discontinued if any serious side effects occur. Weight monitoring during the first 3/4 months allows you to determine the effectiveness of the therapy. If the weight loss is less than 5% of body weight, therapy is considered ineffective and should be discontinued.

The ineffectiveness of one of the methods of therapy does not preclude the use of another drug. Changing the drug substance in therapy requires re-evaluation of the treatment for a period of 3 to 4 months. The ineffectiveness of pharmacological treatments may be an indication for surgery, such as reducing the volume of the stomach.

Drug therapy for obesity is an addition to pro-health lifestyle changes. Maintaining an optimally balanced diet and physical activity is the foundation for effective obesity treatment.

In order to start pharmacological obesity treatment, consult your doctor about your weight loss problem.

Literature:

Lee PC, Dixon J. Pharmacotherapy for obesity. Aust Fam Physician. 2017;46(7):472-477. PMID: 28697290.

Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016 Jun;22(7 Suppl):s176-85. PMID: 27356115.

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