Pharmacologic Therapy for Obesity

Excerpt

Obesity is a pervasive chronic disease that continues to rise in prevalence globally, affecting not just adults but also adolescents and children. It has reached epidemic proportions and is now recognized as a significant health crisis.

Epidemiological studies have defined obesity using the body mass index (BMI), calculated by dividing a person's weight in kilograms by the square of their height in meters. This method enables the stratification of obesity-related health risks within populations. A BMI exceeding 30 kg/m² is considered diagnostic for obesity and is further subclassified into class 1 (30 to 34.9 kg/m²), class 2 (35 to 39.9 kg/m²), and class 3, known as morbid obesity (≥40 kg/m²).

The primary approach to addressing obesity involves promoting weight loss through behavioral therapy, encompassing dietary changes, and adopting a healthy lifestyle with regular physical activity. Weight loss significantly reduces cardiovascular risk factors, aids disease prevention, and enhances self-esteem and overall functionality. While significant weight loss produces benefits in overall mortality, moderate weight loss (5%-10%), achievable through lifestyle modifications and medications, has been shown to significantly improve various conditions, including type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, nonalcoholic fatty liver disease, osteoarthritis, cancer, and sleep apnea.

In addition to these measures, given the challenges associated with weight loss and its maintenance, evidence-based pharmacologic therapy is often deemed necessary to achieve a more effective and sustained response in managing obesity. Healthcare providers are essential in engaging in a shared decision-making process with patients, carefully considering the risks and benefits. This collaborative approach ensures the selection of the most appropriate pharmacotherapy that aligns with the patient's profile.

When these methods prove ineffective, or if there is an urgent need for weight loss and pharmacotherapy has not yielded the desired results, bariatric surgery can be considered. Bariatric surgery has demonstrated significant improvements in morbidity and mortality. Notably, patients who have previously failed to engage in a weight loss program or refuse assistance in a behavioral program are at a high risk of relapse following bariatric surgery. Therefore, surgical intervention may not be the recommended course of action in such cases.