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CHAPTER 23. DRUGS USED FOR THE TREATMENT OF OBESITY

Obesity is manifested by the excessive storage of fat. It results from long-term impairment of the energy balance when energy intake from food exceeds its expenditure, for example, in the case of lack of physical exercise. It is obvious that the main factors contributing to the development of obesity are increased content of fat in the diet and lack of movement (hypodynamia). Hereditary predisposition to obesity should also be considered. Besides, psychological and neuroendocrine factors as well as age are also of great importance.

Obesity1 is a serious medical problem, since it is a risk factor for the development of diabetes mellitus, cardiovascular disorders, osteoarthritis and many other chronic diseases. Besides, the rate of premature death of obese people is increased. Therefore, weight loss is not the only thing that needs to be achieved; in fact the main goal of obesity management is to lower disability and mortality caused by the diseases associated with obesity.

The basic principle of the treatment of obesity is to lower the caloric values of food consumed and enhance physical exercise.

When this approach fails to be sufficient, pharmacotherapy may be initiated.

The drugs used in the treatment of obesity can be divided into the following groups:

 Drugs that suppress appetite and reduce food intake (anorectic drugs, appetite suppressants).

 Drugs that stimulate lipolysis and thermogenesis (antagonists of β3-adrenoceptors).

 Drugs that block fat absorption in the digestive system (lipase inhibitors).

 Drugs that substitute fat due to similar organoleptic properties (they are of low caloric value or not absorbed from the gastrointestinal tract);

 Drugs that substitute sugar (they are not related to carbohydrates and they do not participate in fat synthesis).

1 Body mass index, BMI, is the most frequently used formula: body weight, kg/height, m2. Normal values lie between 20 and 25; values of 25-30 indicate that the person is overweight; when it is over 30. It is indicative of obesity.

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