title: Pharmacotherapy for the treatment of obesity.
abstract: The recognition of the complex counter-regulatory hormonal, metabolic and neurochemical mechanisms that promote weight regain following weight loss and the conceptualisation of obesity as a chronic disease requiring long-term management has led to increasing focus on the role of adjunctive therapies for obesity, particularly pharmacotherapy. Currently available pharmacotherapy achieves a weight loss intermediate between that commonly attained by lifestyle intervention and bariatric surgery, however its accessibility, compared to bariatric surgery increases its appeal. Despite the poor history of obesity pharmacotherapy, novel agents that are in development appear to have several advantages over predecessors. They are generally more selective in their mechanism of action, thereby potentially minimising adverse sequelae and improving the risk-benefit ratio of pharmacotherapy. Another approach has been to use combined pharmacotherapy to better counteract the multiple counter-regulatory neuroendocrine mechanisms which promote weight regain, as well as allowing lower constituent doses of the combined monotherapy agents, which improves the safety and tolerability of these agents that are usually required long-term for chronic weight maintenance. This review will provide an overview of past, present and future pharmacotherapy for obesity. The efficacy and safety profile of currently available pharmacotherapy will be discussed in the setting of stringent regulatory review processes now in place given the fraught history of pharmacological interventions for obesity. Potential novel therapies that seek to better target the multiple complex counter-regulatory mechanisms promoting weight regain while improving the efficacy/safety profile, will also be examined.
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia. Electronic address: aswe6150@uni.sydney.edu.au.
authors.forename: Arianne N
authors.initials: AN
authors.lastname: Sweeting
authors.affiliation: Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Hocking
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia.
authors.forename: Tania P
authors.initials: TP
authors.lastname: Markovic
mesh_terms: D019440:Anti-Obesity Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D009490:Neurosecretory Systems / Q000187:drug effects; D009765:Obesity / Q000188:drug therapy*
chemical_list: D019440:Anti-Obesity Agents
keywords: Obesity; Pharmacotherapy; Review