Actualizaciones en el tratamiento farmacológico de la obesidad

Resumen

The management of obesity is based on therapeutic procedures oriented to reduce food intake and promote energy expenditure in order to achieve a negative caloric balance and a reduction in excessive body fat. Though a balanced low-calorie diet and physical activity represent the essential part of obesity therapy, medical treatments help to achieve the initial reduction and subsequent maintenance of body weight as well as to decrease the impact of associated risk factors such as diabetes, hypertension or dyslipidaemia. Depending on their mechanisms of action the drugs used in the treatment of obesity can be classified in inhibitors of food intake, blockers of nutrient absorption, and promoters of energy expenditure. Adrenergic and serotoninergic agonists represent the most important drug inhibiting food intake. Sibutramine combines noradrenergic, serotoninergic and dopaminergic activities and is being used succesfully, but blood pressure and heart rate should be controlled. Orlistat is an inhibitor of intestinal lipases which blocks the absorption of the 30% of ingested fat. Both drugs have been shown effective to promote body weight reduction as well as an improvement in the control of diabetes and hyperlipidaemia. The use of thermogenic drugs such as the combination caffeine-ephedrine is limited by adrenergic side effects and the treatment with selective beta-3 agonists in humans has yielded disappointing results. Recent investigations on the regulation of food intake and energy expenditure are shedding light on the mechanisms controlling appetite and satiety, raising new pharmacological possibilities for obesity treatment. Several compounds such as tesofensin, and new satiating compounds and orexigenic hormone antagonists may demonstrate in the near future their efficacy in the treatment of obesity and its related comorbidities. As new compounds acting at different levels of the energetic equation will be delivered, an increase in the strategic relevance of pharmacological treatment of obesity is to be expected.