The growing recognition of the health risks of obesity coupled with the
difficulties in treating it successfully by lifestyle modification
predicates a need for effective drug treatment. The history of drug
treatment in the second half of the 20th century is, however, one of
disappointment and concern over drug toxicity. However, the advances in
our understanding of the mechanism of weight control, together with
improved ways of evaluating anti-obesity drugs, has resulted in two
effective compounds, sibutramine and orlistat, becoming available for
clinical use. Sibutramine has actions on both energy intake and
expenditure and had been shown to enhance weight loss and weight
maintenance achieved by diet, in simple obesity as well as when
accompanied by complications of diabetes or hypertension. About 50–80%
of patients can achieve a >5% loss, significantly more than if
patients receive the same lifestyle intervention with placebo. Orlistat,
which acts peripherally to block the absorption of dietary fat, has had
similar results in clinical trials; a recent study (XENDOS) has just
reported results which show that the enhanced, albeit modest, weight
loss achieved with orlistat delays the development of diabetes over a
4-year period. A number of other compounds are expected to complete or
enter clinical trials over the next decade. There is considerable
optimism that we will soon have the pharmacological tools needed to make
the treatment of obesity feasible...
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