Pharmacological treatment of obesity

Abstract

Overweight and obesity cause many diseases, such as type II diabetes and cardiovascular diseases. Each extra body weight kilogram increases the risk of cancer, including cancer of the oesophagus, kidneys, and pancreas, hepatocellular carcinoma, or cardia cancer stomach. In recent decades, an increase in the number of people affected by obesity has been observed. For this reason, the problem is now called the epidemic of obesity. This epidemic affects not only adults but also younger children. Regular physical activity and changing dietary habits are the basis of the treatment of obesity or overweight. In case when the intended therapeutic goals are not achieved, it is possible to start pharmacological treatment. Obesity treatment has changed significantly over the years. Many drugs with this indication, introduced into treatment in the 20th and 21st centuries, have been withdrawn due to the discovery of serious side effects. This concerned phentermine, mazindol, sibutramine, and rimonabant. Currently, there are four drugs for treating obesity available in Poland. The oldest of them, orlistat, was placed on the market in 1998. The combination of naltrexone/bupropion and liraglutide have been available since 2015. In 2021, setmelanotide was registered, used only in cases of obesity resulting from rare genetic diseases. In this article, a review of their chemical structure, mechanism of action, effectiveness, and adverse reactions was carried out. Furthermore, semaglutide was described, the second after liraglutide drug from the group of the incretin hormone analogs, glucagon-like peptide 1. In Poland, it is registered only as an antidiabetic drug, but in the United States, it has also been used as an antiobesity drug since 2021. The presence of this drug on the market and the promising results of clinical trials mean that it is prescribed off-label for the treatment of obesity also in Poland. New therapies for obesity treatment give hope for effective and less risky problem solution than bariatric surgery. It should be remembered that only the combination of a healthy diet, exercise, and pharmacological treatment gives the best and most lasting results in obesity therapy.