Options for long-term obesity treatment
Obesity is a chronic disease, and it cannot be cured quickly. A patient should understand that overweight has been accumulating for a long time, so time is also needed to normalize it.
Duration of weight loss program is determined according to obesity severity. Therapy of severe forms of obesity, such as morbid, should take at least 9 months.
Importance of long-term obesity therapy:
1. Short-term use of medicines is invariably accompanied with weight regain.
2. After using medications and achieving the ideal weight, obesity treatment is not finished. Complex weight loss programs (including exercise and compliance with a diet plan) can provide sustainable behavioral changes preventing relapse of weight gain.
3. Weight reduction gradually improves symptoms of concomitant diseases: lipid profile and blood circulation are improved, as well as insulin sensitivity increases.
Diet therapy is a major part of obesity treatment. However, change in daily diet for a long period is an impossible task for patients suffering from morbid obesity.
Just as diet therapy, physical activity is an integral part of weight loss program. However, increase in physical activity is impossible for many patients because of pathology of the musculoskeletal system and / or cardiac and respiratory failure.
To facilitate compliance with the diet plan for the patient, pharmacotherapy should become an integral part of weight loss program. In addition, drugs can improve physical state to such an extent that the patient will be able to increase physical activity, even if initially he was not able to carry out physical exercise.
Many centrally acting drugs, reducing appetite, were withdrawn from production because of pronounced side effects. Sibutramine was the only anorectic, suitable for long-term (about 1 year) obesity treatment. Other drugs (Fenfluramine, Mazindol and others) could only be used as short-term obesity therapy.
Currently, drugs of the following pharmacological groups are used for weight loss:
- sympathomimetics: Diethylpropion, Phentermine
- inhibitor of gastrointestinal lipases: Orlistat
- analogue of a glucagon-like peptide: Liraglutide.
Since sympathomimetics have a pronounced stimulating effect on the central nervous system, the maximum duration of using Phentermine or Diethylpropion should not exceed 3 months. Thus, none of the currently available sympathomimetics is not suitable for long-term obesity treatment.
Prior to introduction of Orlistat into clinical practice in the late 1990s, long-term pharmacotherapy of obesity was impossible. Unlike sympathomimetics, having a central effect, Orlistat is a non-systemic drug, which acts only in the lumen of the intestine.
Advantages of Orlistat in long-term obesity therapy:
Duration of using Orlistat for obesity treatment can make about 2 years.
For long-term obesity therapy, not only oral medications can be used. The main difference of Liraglutide from all other drugs for weight loss is a route of administration – subcutaneous injections. Clinical trials have confirmed effectiveness of subcutaneous injections Liraglutide for long-term obesity treatment for more than 1 year.
Thus, Orlistat and Liraglutide are suitable for long-term obesity therapy and they can be used until the ideal weight is achieved. Herewith, none of endocrinologists will not recommend indefinite duration of obesity pharmacotherapy. The attending physician must select duration of using this or that drug individually for each patient.
The long history of treating obesity testifies not only about use of those drugs that were specifically designed for weight loss.
Scientists and researchers were repeatedly made attempts to use drugs for weight loss, which were originally developed for treatment of other diseases.
Examples of inefficient use of drugs for weight loss are Fluoxetine and Sertraline. Initially developed for treatment of mental illness, Fluoxetine and Sertraline have long been considered as promising drugs for weight loss. However, antidepressants have not undergone clinical trials on effectiveness in weight loss.
Therefore, medications approved for treatment of other diseases (Fluoxetine, Sertraline) should not be used for the sole purpose of weight loss. Obesity therapy with such drugs can be prescribed as a part of the study performed by medical specialists with experience in obesity treatment.
Just as any other chronic disease, obesity treatment should be long-term. That is, a set of measures aimed at active reducing excess body weight should not result in returning to a diet and lifestyle the patient is accustomed to. Even after completion of pharmacotherapy, the patient should follow diet plan and regularly engage in physical activity.