Pharmacological treatment of obesity

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The pharmacological treatment of obesity has been a source of both great hope and controversy. In 1992, interest in pharmacotherapy increased with the report from Weintraub et al.(34) that low doses of fenfluramine (30 mg/day) combined with phentermine (15 mg/day), produced substantial weight losses that were maintained for as long as 3 years. This interest was dashed by the report in 1997 that fenfluramine and dexfenfluramine, when taken in combination with phentermine, were associated with cardiac valvular damage. They were promptly withdrawn from the market.(35)

Intensive pharmaceutical research now under way will probably produce safe and effective medication for weight control within the next few years. Already two new medications, sibutramine(36) and orlistat,(37) have been approved for long-term use in several countries.

Patient selection

Weight-loss medications are usually reserved for patients with a body mass index over 30 kg/m 2 who have failed to reduce with conservative approaches. They may also be appropriate for patients with a body mass index over 27 kg/m2 who have a comorbid condition which will be improved with weight loss. Weight-loss medications are inappropriate for lactating or pregnant women, as well as for people with eating disorders (i.e. anorexia nervosa and bulimia nervosa). (38)

Approved weight-loss medications

Ia.ble.4 shows prescription weight-loss medications approved for use in the United States and/or the European Union. With the exception of sibutramine, these agents have been approved for only short-term use (up to 3 months), and there are no long-term data on their safety and efficacy. (39)

Table 4 Weight-loss medications currently approved by the United States Food and Drug Administration

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