new treatment modalities for Obesity

 

ABSTRACT: Obesity is linked to health conditions including diabetes, hypertension, dyslipidemia, and cancer. Chronic drug therapy for obesity has been limited by cardiovascular (CV) and/or gastrointestinal adverse events (AEs), but two recently approved drugs lorcaserin (Belviq) and phentermine and topiramate extended-release (Qsymia) may prove helpful for achieving weight loss in obese patients. Lorcaserin is the first approved serotonin (5-HT)2C receptor agonist. The phentermine and topiramate extended-release combination is thought to work by suppressing appetite, reducing caloric intake and energetic efficiency, and increasing energy expenditure.
The drugs’ efficacy cannot be compared directly at present, and it remains to be seen whether these agents are associated with an increased risk of CV AEs.

•• Current National Health and Nutrition Examination Survey data on obesity prevalence indicate that, in the period from 2009 to 2010, more than onethird of adults and almost 17% of children and adolescents were obese.
The Healthy People 2010 goals of 15% obesity among adults and 5% obesity among children were not met, and the threat of obesity-related health conditions continues to rise. Obesity-related health conditions include type 2 diabetes (T2DM), hypertension, dyslipidemia, coronary heart disease (CHD), stroke, gallbladder disease, osteoarthritis, sleepapnea and respiratory problems, and certain types of cancer (endometrial, breast, prostate, and colon).

•• FACTORS INVOLVED IN OBESITY
The pathophysiology of obesity is complex and multifactorial, involving physiological, genetic, and behavioral components. A certain amount of stored fat is required for survival during times of malnutrition or starvation.
However, as weight increases, excess adipocytes release surplus free fatty acids, leading to lipotoxicity, insulinreceptor dysfunction, and hyperglycemia.
In particular, white adipose tissue releases prefatty acids and adipokines, which are lipotoxic and inflammatory. The diverse effects of inflammatory adipokines includehyperglycemia, endothelial dysfunction, atheroma formation, plaque, and thrombosis. These injurious inflammatory secretagogues are countered by anti-inflammatory hormones such as adiponectin, visfatin, and acylation-stimulating protein.

•• The influence of another factor the obesogenic environment on weight has yet to be fully understood.
The obesogenic environment is “the sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations. Multiple factors, including the built environment (physical design, land-use patterns, transportation systems) and the food and nutrition environments (food access, advertising, marketing), must be addressed in order to truly make progress in the areas of obesity prevention and intervention.