Drug treatments for obesity

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A brief overview of your interest group (be sure to put its name in bold in the first sentence) and the scope of the article goes here.

The following list of sections should serve as a loose guideline for developing the body of your article. The works cited in references 2-5 are all fake; their purpose is to serve as a formatting model for your own citations.

Introduction

History

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Limited Efficacy

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Serotonin & Noradrenaline Related Drugs

By Bruce McLintock

Endocannabinoids

By Neil R. J. Watson

One method of pharmaceutically tackling obesity is to give cannabinoid receptor type 1 (CB1 receptor) antagonists such as rimonabant. Mice genetically engineered to be deficient in CB-1 receptors have been shown to be resistant to diet induced obesity. Numerous clinical trials have demonstrated weight loss in obese subjects, as well as improving the ratio of good (HDL) to bad (LDL) cholesterol. However, a major issue in using CB1 antagonists is the incidence of psychiatric problems, in particular, depression (unfortunately several suicides occured during trials). As a result, the FDA has not approved the use of rimonabant in the United States. The European Medicines Agency (EMEA) has recommended the marketing authorisation of rimonabant be suspended across the EU, and consequently NICE has withdrawn its guidance for the use of the drug.

http://eurheartj.oxfordjournals.org/cgi/reprint/ehn255v1.pdf http://www.nice.org.uk/TA144

Peripheral Drugs

By Rachael Kirkbride

[REMINDER TO SELF: NEED BIT MORE ON METHOD OF ACTION, AND OTHER PERIPHERAL DRUGS]

‘Peripherally acting anti-obesity drugs’ are another class of medication aimed at causing weight loss in overweight and obese individuals. These work by reducing the calorie intake from food, or altering the metabolism of it in the gastrointestinal system (gut). There is currently only one drug of this kind that is approved for use globally - Orlistat (Xenicol) - and it works by inhibiting the enzyme lipase that breaks down fat in the gut, meaning that the fat cannot be absorbed from food, and instead it is excreted out of the body.[3]. Studies have shown that is can reduce the amount of fat absorbed from the gut by 30%, causing a decreased calorie intake and therefore weight loss. The weight loss from taking this medication is found to be between 5-10% on average.[2][6]. As well as weight loss, Orlistat has been shown to improve several other cardiovascular risk-factors. Low-density lipoproteins (LDL) and triglyceride levels were shown to be reduced by 10% more than expected for the weight loss, as well as blood pressure, waist circumference and lipids being reduced.[2][5]. Some research also suggests that Orlistat reduces fasting glucose and HbA1c levels in type 2 diabetics by more than predicted for the weight loss, with suggested methods including increased insulin sensitivity and glucagon-like peptide-1 secretion in the small intestine. Orlistat also helps to reduce the risk of type 2 diabetes in obese subjects by 37.3%. [2].

However, this drug does not come without some side-effects. Oily-spotting, flatulence, abdominal cramps, faecal urgency/incontinence and liquid stools are the common adverse effects of Orlistat, due to an increase of fat in the gut and stools.[3]. These side-effects are reported to only be experienced during the early stages, “but they subside as patients learn to use the drug”.[4]. Orlistat also prevents some absorption of fat-soluble vitamins (A,E,D,K), and so patients are recommended to take supplements.[3]. The drug does not have any systemic side-effects as it is contained in the gut, however it does affect the absorption of acyclovir, and they shouldn’t be used at the same time. [4].

In 2001 the NHS National Institute for Health and Clinical Excellence (NICE) issued a press release on guidance for Orlistat use, and it states that it is cost effective to the NHS.[8]. Studies have also shown that Orlistat is a cost-effective drug in obese adults.[2].

Other Drug Therapies

Off Label Uses of Prescribed Medication

Anti-Diabetic Medication

No.

Reference: Review: Role of metformin for weight management in patients without type 2 diabetes. #CAN'T ACCESS#

Reference: Review: Is there a role for metformin or acarbose as a weight-loss agent in the absence of diabetes?

Diuretics

Reference: Review: Effects of Antihypertensive Therapy onInsulin Resistance [Kaplan N. M.]

Thyroid Hormones

Reference: Review: Thyroid hormones in the pathogenesis and treatment of obesity [Krotkiewski M.]

Reference: Review: New Targets for Obesity Pharmacotherapy [Aronne L. J.]

Caffeine

Reference: Review: The safety and efficacy of pharmaceutical and herbal caffeine and ephedrine use as a weight loss agent [Greenway et Al.]