Pharmacological Management Of Obesity Research Articles

The Role of Semaglutide in Weight Management: An Analysis of Clinical Studies for Overweight and Obese Adults

Obesity is a mounting global health challenge, and recent advancements in pharmacologic interventions have brought new hope to this complex issue. One such intervention, semaglutide, marketed as Ozempic and Wegovy, has shown promising results in weight management among adults with overweight or obesity. This paper synthesizes findings from key clinical studies to evaluate the efficacy, safety, and long-term impact of semaglutide in weight management. Semaglutide, initially developed for type 2 diabetes management, functions by mimicking the human glucagon-like peptide-1, thereby reducing appetite and food intake. Regulatory bodies in the United States, Europe, the United Kingdom, and Canada have approved its use for weight mana gement at a weekly dose of 2.4 mg, marking a significant step in obesity treatment. Alongside its benefits, the paper also addresses the safety profile and adverse effects associated with semaglutide. While generally well-tolerated, rare but serious adverse effects have been reported, necessitating a careful assessment of risks and benefits in clinical practice. In conclusion, semaglutide presents a significant advancement in the pharmacologic management of obesity. Its ability to induce considerable weight loss, coupled with improvements in cardiovascular and metabolic health, positions it as a promising tool in the arsenal against obesity. Future research should focus on long-term efficacy, safety, and the integration of comprehensive lifestyle interventions to optimize treatment outcomes.

Review article: Pharmacologic management of obesity - updates on approved medications, indications and risks.

Obesity has reached epidemic proportions, with >40% of the US population affected. Although traditionally managed by lifestyle modification, and less frequently by bariatric therapies, there are significant pharmacological advancements. To conduct a narrative review of the neurohormonal and physiological understanding of weight gain and obesity, and the development, clinical testing, indications, expected clinical outcomes, and associated risks of current FDA-approved and upcoming anti-obesity medications (AOMs). We conducted a comprehensive review in PubMed for articles on pathophysiology and complications of obesity, including terms 'neurohormonal', 'obesity', 'incretin', and 'weight loss'. Next, we searched for clinical trial data of all FDA-approved AOMs, including both the generic and trade names of orlistat, phentermine/topiramate, bupropion/naltrexone, liraglutide, and semaglutide. Additional searches were conducted for tirzepatide and retatrutide - medications expecting regulatory approval. Searches included combinations of terms related to mechanism of action, indications, side effects, risks, and future directions. We reviewed the pathophysiology of obesity, including specific role of incretins and glucagon. Clinical data supporting the use of various FDA-approved medications for weight loss are presented, including placebo-controlled or, when available, head-to-head trials. Beneficial metabolic effects, including impact on liver disease, adverse effects and risks of medications are discussed, including altered gastrointestinal motility and risk for periprocedural aspiration. AOMs have established efficacy and effectiveness for weight loss even beyond 52 weeks. Further pharmacological options, such as dual and triple incretins, are probable forthcoming additions to clinical practice for combating obesity and its metabolic consequences such as metabolic dysfunction-associated steatotic liver disease.

Obesity management for the pre–liver transplant and post–liver transplant patient

Obesity management for the pre–liver transplant and post–liver transplant patient

Pharmacological Management of Obesity in Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. A substantial proportion of patients with PCOS are either overweight or obese, and excess body weight aggravates the hormonal, reproductive and metabolic manifestations of PCOS. In recent years, several studies evaluated the role of various pharmacological agents in the management of obesity in this population. Most reports assessed glucagon-like peptide-1 receptor agonists and showed a substantial reduction in body weight. More limited data suggest that sodium-glucose cotransporter-2 inhibitors and phosphodiesterase-4 inhibitors might also be effective in the management of obesity in these patients. In the present review, we discuss the current evidence on the safety and efficacy of these agents in overweight and obese patients with PCOS.

Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine

Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons. What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century? To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States. The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine. Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient. The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.

Use of prescription medications associated with weight gain among US adults, 1999-2018: A nationally representative survey.

This study aimed to evaluate trends in the use of obesogenic medications among adults. Cross-sectional data on adults aged ≥20 years are from the 1999 to 2018 National Health and Nutrition Examination Survey (n = 52,340). Obesogenic medications were defined according to the 2015 Endocrine Society guidelines on the pharmacological management of obesity. Weight status was categorized according to BMI. Trends in prior 30-day use were evaluated. In NHANES 2017-2018, 20.3% of US adults used an obesogenic medication. Beta-blockers (9.8%) and antidiabetics (5.7%) were the most common; antipsychotics (1.0%) were the least common. Most common indications were disorders of glucose metabolism, hypertension, neuralgia or neuritis, heart disease, and musculoskeletal pain and/or inflammation. From 1999 to 2018, the proportional use of obesogenic medications increased for anticonvulsants (34.4% to 55.0%) but decreased for antidepressants (32.1% to 18.8%), antidiabetics (82.9% to 52.5%), and beta-blockers (83.9% to 80.7%). The proportional use of obesogenic medications was not associated with weight status, except for antipsychotics. Use of obesogenic medications was common. Differences in the proportional use of obesogenic medication may reflect changing availability of obesogenic versus nonobesogenic medications over time. The decision to prescribe a nonobesogenic alternative, if one exists, is guided by weighing the risks and benefits of available treatments.

Evaluation of the Predictive Ability, Environmental Regulation and Pharmacogenetics Utility of a BMI-Predisposing Genetic Risk Score during Childhood and Puberty.

Polygenetic risk scores (pGRSs) consisting of adult body mass index (BMI) genetic variants have been widely associated with obesity in children populations. The implication of such obesity pGRSs in the development of cardio-metabolic alterations during childhood as well as their utility for the clinical prediction of pubertal obesity outcomes has been barely investigated otherwise. In the present study, we evaluated the utility of an adult BMI predisposing pGRS for the prediction and pharmacological management of obesity in Spanish children, further investigating its implication in the appearance of cardio-metabolic alterations. For that purpose, we counted on genetics data from three well-characterized children populations (composed of 574, 96 and 124 individuals), following both cross-sectional and longitudinal designs, expanding childhood and puberty. As a result, we demonstrated that the pGRS is strongly associated with childhood BMI Z-Score (B = 1.56, SE = 0.27 and p-value = 1.90 × 10−8), and that could be used as a good predictor of obesity longitudinal trajectories during puberty. On the other hand, we showed that the pGRS is not associated with cardio-metabolic comorbidities in children and that certain environmental factors interact with the genetic predisposition to the disease. Finally, according to the results derived from a weight-reduction metformin intervention in children with obesity, we discarded the utility of the pGRS as a pharmacogenetics marker of metformin response.

Mo2027 – High Stress Level is Associated with Low Motivation, Confidence and Rating of Social Support for Weight Management in Participants in a Clinical Trial on Pharmacologic Management of Obesity

Mo2027 – High Stress Level is Associated with Low Motivation, Confidence and Rating of Social Support for Weight Management in Participants in a Clinical Trial on Pharmacologic Management of Obesity

Combating osteoporosis and obesity with exercise: leveraging cell mechanosensitivity.

Osteoporosis, a condition of skeletal decline that undermines quality of life, is treated with pharmacological interventions that are associated with poor adherence and adverse effects. Complicating efforts to improve clinical outcomes, the incidence of obesity is increasing, predisposing the population to a range of musculoskeletal complications and metabolic disorders. Pharmacological management of obesity has yet to deliver notable reductions in weight and debilitating complications are rarely avoided. By contrast, exercise shows promise as a non-invasive and non-pharmacological method of regulating both osteoporosis and obesity. The principal components of exercise - mechanical signals - promote bone and muscle anabolism while limiting formation and expansion of fat mass. Mechanical regulation of bone and marrow fat might be achieved by regulating functions of differentiated cells in the skeletal tissue while biasing lineage selection of their common progenitors - mesenchymal stem cells. An inverse relationship between adipocyte versus osteoblast fate selection from stem cells is implicated in clinical conditions such as childhood obesity and increased marrow adiposity in type 2 diabetes mellitus, as well as contributing to skeletal frailty. Understanding how exercise-induced mechanical signals can be used to improve bone quality while decreasing fat mass and metabolic dysfunction should lead to new strategies to treat chronic diseases such as osteoporosis and obesity.

Updates on obesity pharmacotherapy.

Obesity is a chronic, relapsing disease that necessitates a multidisciplinary approach to management. Behavioral changes are the foundation to management, but adjunctive therapy is often warranted, including pharmacologic therapies and/or bariatric surgery. Until recently, treatment options included only short-term therapy (≤12 weeks), and paths beyond that schedule were challenging, as knowledge of the biology of obesity was lacking. With increased recognition of obesity as a chronic, complex medical disease, newer agents have been approved as long-term therapy, and the cornerstone of treatment is chronic behavior and lifestyle change. In the last decade, the Food and Drug Administration (FDA) has approved several new weight loss medications for the chronic management of obesity. In this review paper, we provide the latest updates on obesity pharmacotherapy. The main areas we will cover include (1) pharmacological management of obesity, (2) a review of FDA-approved weight loss medications, (3) comanagement of obesity and its metabolic sequelae (type 2 diabetes mellitus, hypertension, and dyslipidemia), and (4) obesity-centric prescribing for mental illness, neurological disorders, and contraceptive planning.

Early improvement in food cravings are associated with long-term weight loss success in a large clinical sample

Background:Food cravings are associated with dysregulated eating behaviour and obesity, and may impede successful weight loss attempts. Gaining control over food craving is therefore a component in the management of obesity. The current paper examined whether early changes in control over food craving (assessed using the Craving Control subscale on the Control of Eating Questionnaire (CoEQ)) was predictive of weight loss in four phase 3 clinical trials investigating a sustained-release combination of naltrexone/bupropion (NB) in obese adults. The underlying component structure of the CoEQ was also examined.Method:In an integrated analysis of four 56-week phase 3 clinical trials, subjects completed the CoEQ and had their body weight measured at baseline and at weeks 8, 16, 28 and 56. All analyses were conducted on subjects who had complete weight and CoEQ measurements at baseline and week 56, and had completed 56 weeks of NB (n=1310) or placebo (n=736). A latent growth curve model was used to examine whether early changes in the CoEQ subscales were associated with decreases in weight loss over time. Confirmatory factor analysis (CFA) was used to determine the psychometric properties of the CoEQ.Results:The factor structure of the CoEQ was consistent with previous findings with a four-factor solution being confirmed: Craving Control, Positive Mood, Craving for Sweet and Craving for Savoury with good internal consistency (Cronbach’s α=0.72–0.92). Subjects with the greatest improvement in Craving Control at week 8 exhibited a greater weight loss at week 56.Conclusions:These findings highlight the importance of the experience of food cravings in the treatment of obesity and support the use of the CoEQ as a psychometric tool for the measurement of food cravings in research and the pharmacological management of obesity.

Pharmacological Management of Obesity in Patients with Type 2 Diabetes: An Update

Pharmacological Management of Obesity in Patients with Type 2 Diabetes: An Update

The pharmacological management of obesity

Obesity is a growing phenomenon and a global concern. It is well-known that it plays a significant role in the development of several preventable diseases. The physiological mechanisms in regulating energy intake and expenditure are complex and remain a target area for current and future research. The absence of a golden standard in determining the body’s composition provides for various measurement techniques, each with its own advantages and disadvantages. Lifestyle changes and reduced caloric intake form the backbone of any pharmacological intervention. A myriad of therapeutic agents are available which offer the provision for individualised treatment.

Pharmacologic Approaches to Weight Management: Recent Gains and Shortfalls in Combating Obesity.

Obesity is a growing epidemic in the USA with over one third of adults presently classified as obese. Obesity-related comorbidities include many leading causes of preventable death such as heart disease, stroke, type 2 diabetes, and certain types of cancer. Modest weight loss of 5-10% of body weight is sufficient to produce clinically relevant improvements in cardiovascular disease risk factors among patients with overweight and obesity. Until recently, there were limited pharmacologic options approved by the Food and Drug Administration to treat obesity. Phentermine/topiramate ER and lorcaserin were approved in 2012, and naltrexone SR/bupropion SR and liraglutide 3.0mg were approved in 2014. This article reviews recent literature in the field of Obesity Medicine and highlights important findings from clinical trials. Future directions in the pharmacologic management of obesity are presented along with new diabetes medications that promote weight loss and reduce cardiovascular mortality.

Pharmacological Management of Obesity in Pediatric Patients

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated.

Pharmacological management of obesity: Past, present and future

Obesity is the problem of children, adolescents and the elderly because it is a problem that affects all ages. Obesity leads to many metabolic disorders diabetes, hyperlipidemia, hypertension, angina, depression, indigestion and arthritis. There were several studies and reviews presented on the treatment modality in literature for obesity. But there are no comprehensive reviews on anti-obesity drugs till date. In the present review, we are presenting the pharmacological management of obesity. The literature search carried out using electronic search engines through PubMed, Biological Abstracts, BIOSIS PREVIEWS, Current Contents® /Clinical Medicine, Current Contents® /Life Sciences, EBSCO, ScienceDirect, Ingenta, Springer, Wiley Interscience, J-STAGE, Google scholar and Scifinder from 1990 to September 2013. Based on this search, we are presenting a brief review on pharmacological management of obesity, with a focus on the drugs used in the past, present and future. From this search, it is revealed that some of the drugs approved earlier for treating obesity were withdrawn from the market (Phentermine, Dexfenfluramine, Fenfluramine and Sibutramine). Some of the older drugs are introduced in combination form (Phentermine + Topiramate (Qnexa), Empatic, Concave). Most of the adrenergic and serotonergic drugs possesses adverse effects like increasing heart rate and hypertension. Similarly, some new drugs came into the market for treating obesity (Lorcaserin, Orlistat,) and few are in clinical trials in different phases of drug development (APD-365, CD-945,598, MK-0364, ATL-962, GT-389-255, AOD9604, Leptin, Peptide3-36, obinepitide and TM30338). The drugs that are under clinical trials were subjected for evaluating the safety and efficacy. We have to see in the future how many of these drugs are going to be available for treating obesity.

Challenges in the Pharmacologic Management of Obesity and Secondary Dyslipidemia in Children and Adolescents

The rise in childhood obesity has lead to an increased number of children with lipid abnormalities and the predominance of a combined dyslipidemic pattern characterized by a moderate-to-severe elevation in triglycerides, normal-to-mild mild elevation in LDL cholesterol and reduced HDL cholesterol. Although recently published National Heart, Lung and Blood Institute (NHLBI) guidelines represent a significant step forward in managing primary dyslipidemias in pediatric patients, there is still no general consensus regarding the pharmacologic treatment of obesity-related lipid abnormalities in children. The use of early pharmacologic intervention to control dyslipidemias and reduce cardiovascular risk in young children is only expected to increase given the steady increase in obesity and emergence of atherosclerotic disease in pre-adolescents. Despite the increasing use of lipid-lowering therapy in children over the last few years, diet and lifestyle modification remain the first line therapy. Given the challenges of instituting and maintaining lifestyle modification in pediatric patients, however, it is likely that institution of drug therapy may be required in many children. Of all the medications currently available, the fibric acid derivatives have a cholesterol lowering profile that is most likely to be effective in obese children with the high TG/low HDL phenotype and data from a recently published study of gemfibrozil in children with metabolic syndrome are promising. However, additional information regarding the short and long-term safety and efficacy of fibrate therapy in children with obesity-related lipid disorders is needed before use of these agents can be recommended.

Type 2 Diabetes in Children and Adolescents.

Anticipatory guidance regarding healthy eating and active lifestyle is recommended to prevent obesity. Regular targeted screening for type 2 diabetes is recommended in children at risk. Children with type 2 diabetes should receive care in consultation with an interdisciplinary pediatric diabetes healthcare team. Early screening, intervention and optimization of glycemic control are essential, as the onset of type 2 diabetes during childhood is associated with severe and early onset of microvascular complications.

Pharmacologic management of obesity

Recent discoveries of processes that govern regulation of body weight and energy expenditure have led to development of new anti-obesity pharmacological agents. This article will inform health professionals of new anti-obesity medications that target neuronal systems within the central nervous system (CNS) and peripheral humoral proteins that send signals to the CNS. An emerging theme of new therapies is to use combination medications that are directed toward several targets or leverage existing gastrointestinal satiety hormonal signals. By using combination therapies, it is anticipated that greater weight loss will be achieved compared to monotherapy.

Bariatric surgery – not to be taken lightly

Bariatric surgery – not to be taken lightly