[Pharmacological treatment of obesity].
The pharmacological treatment of obesity should be considered when cannot be achieved a 10% weight loss with diet therapy and physical activity. The drugs effective in obesity treatment may act by different mechanisms such as reduction in food intake, inhibition of fat absorption, increase of thermogenesis and stimulation of adipocyte apoptosis. At present, we only have two marketed drugs for obesity treatment. Sibutramine is an inhibitor of norepinephrine, dopamine and serotonina reuptake which inhibits food intake and increases thermogenesis. Sibutramine administration for a year can induce a weight loss of 4-7%. Its main side effects are hypertension, headache, insomnia and constipation. Orlistat is an inhibitor of pancreatic lipase which is able to block the absorption of 30% of ingested fat. Its administration induces weight loss and reduction of ulterior weight regain. Also, this drug improves hypertension dyslipdaemia and helps to prevent diabetes in 52% of cases when administered over four years. The increase in frequency of stools and interference with vitamin absorption are its main side effects. Glucagon-like peptide 1, which increases insulin sensitivity and satiety, adiponectin and PPAR-gamma agonists which reduce insulin resistance and modulates adipocyte generation are the basis for future therapeutic approaches of obesity. Phosphatase inhibitors induce PPAR-gamma phosphorylation and UCP-1 expression leading to an increase in thermogenesis and reduction in appetite.
Gomis Barbará
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Servicio de Endocrinología, Nutrición y Diabetes, Hospital Clínic, Barcelona. gomis@medicina.ub.es
D052242:Adiponectin; D000818:Animals; D019440:Anti-Obesity Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D003503:Cyclobutanes / Q000009:adverse effects / Q000627:therapeutic use; D015195:Drug Design; D005544:Forecasting; D005934:Glucagon / Q000502:physiology; D052216:Glucagon-Like Peptide 1; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000139:chemically induced; D036341:Intercellular Signaling Peptides and Proteins; D007783:Lactones / Q000009:adverse effects / Q000627:therapeutic use; D008286:Malabsorption Syndromes / Q000139:chemically induced; D009765:Obesity / Q000188:drug therapy*; D000077403:Orlistat; D010446:Peptide Fragments / Q000502:physiology; D011498:Protein Precursors / Q000502:physiology; D011506:Proteins / Q000502:physiology; D018160:Receptors, Cytoplasmic and Nuclear / Q000819:agonists; D022722:Thermogenesis / Q000187:drug effects; D014157:Transcription Factors / Q000819:agonists; D015431:Weight Loss
D052242:Adiponectin; D019440:Anti-Obesity Agents; D003503:Cyclobutanes; D036341:Intercellular Signaling Peptides and Proteins; D007783:Lactones; D010446:Peptide Fragments; D011498:Protein Precursors; D011506:Proteins; D018160:Receptors, Cytoplasmic and Nuclear; D014157:Transcription Factors; D052216:Glucagon-Like Peptide 1; D005934:Glucagon; D000077403:Orlistat; C058254:sibutramine
Tratamiento farmacológico de la obesidad.