Endocrine Abstracts

It is now accepted that the medical consequences of obesity require and justify effective medical strategies to be used alongside attempts at lifestyle modification. Evaluation of , and true clinical outcomes require trials of many years duration.

At present drug treatment is limited. Two drugs have been approved by NICE after systematic reviews. Orlistat inhibits gastric and pancreatic lipases to produce 30% fat malabsorption. A number of trials for up to 2 years have evaluated orlistat in obesity both 'simple' and complicated by hypertension or diabetes. In conjunction with a hypocaloric diet and regular supervision, mean weight loss at one year (intention to treat analysis) is about 10% in those receiving orlistat 360 mg daily, compared to 7% in those on placebo. Orlistat treatment is associated greater falls in total cholesterol, LDL cholesterol, Lipoprotein (a), fasting blood glucose and diastolic blood pressure than placebo. Sibutramine, by inhibiting the re-uptake of released serotonin and noradrenaline from hypothalamic neurones, reduces food intake and reduce the decline in energy expenditure seen with weight loss and dieting. In one trial, after two years of treatment, sibutramine at a dose of 15-20 mg resulted in 46% of patients maintaining a 10% weight loss or greater. Diabetics treated with sibutramine show significant improvement in glycated haemoglobin in conjunction with weight loss.

Several new drugs (acting on cannabinoid, 5HTc brain receptors, leptin analogues, peripherally acting) are in Phase I-III development. However the increasing availability and safety of surgical techniques, with their proven benefit in clinical outcome, sets a high standard for pharmacotherapy.

anti-obesity treatments is problematic: there are high drop-out rates, regulatory agencies' requirement for optimal lifestyle treatment to be co-administered may obscure a drug effect, weight loss and weight loss maintenance can rarely be evaluated separately