Obesity is a disease that can be defined as excessive amounts of body fat and is associated with increased risk of serious illness, disability, and death. In clinical practice, obesity is best assessed by calculating body mass index and measuring waist circumference (Wyatt, H.R. 2013). Treatment options are based on the body mass index, waist circumference, and adverse health consequences the patient is experiencing or is at an increased risk for facing in the future.
Today, overweight and obesity impacts the majority of people although endocrinologists are uniquely positioned to treat them. “Type 2 diabetes and obesity are very much intertwined. Treatment of each disease affects the other. For these reasons, endocrinologists need to be experts in the treatment of obesity as well as diabetes” (Wyatt, H.R. 2013). Globally, about 387 million people or 8.3% of the world’s population have diabetes. Some 60% of all people with diabetes live in Asia, where inhabitants on average develop diabetes earlier and at lower weights (Bret S. Stetka et al March 30, 2015)
The top countries in the world for average daily calorie consumption are:
- Austria: 3784
- Turkey: 3680
- United States: 3639
- Egypt: 3557
- Germany and Italy: 3539
(Bret S. Stetka et al March 30, 2015)
Diet, exercise, and behavioral modification should be included in all obesity management approaches for body mass index (BMI) of 25 kg/m 2 or higher. Pharmacologic therapy – Few drugs are available for the treatment of obesity. Because all medications inherently have more risks than diet and exercise do, pharmacologic therapy should be used only in patients in whom the benefit justifies the risk.
Surgery – In patients with morbid obesity associated with comorbidities, bariatric surgery is the only available therapeutic modality associated with clinically significant and relatively sustained weight loss.
Traditional pharmacological monotherapies for obesity, although initially successful in achieving weight loss, are often subject to counter-regulation (Rodgers, R.J. et al, 2012). Polytherapy is a future treatment and the advantages of polytherapy include the use of lower drug doses, possible synergistic but at least additive weight loss, less serious side effects and reduced potential for counter-regulation.
Another recent strategy involves the development of single-peptide molecules that combine differing modes of action. Glucagon is a pancreatic hormone with well-established thermogenic, anorectic and weight loss effects in animals and it is known to improve glycaemic control and weight loss in humans with type 2 diabetes.
Another new obesity treatment is Gelesis 100, a cross between a pill and a device. This device is filled with tiny particles created with raw materials used in food products that soak up water and expand in the stomach (Bret S. Stetka et al March 30, 2015). They also mix with digested food and slow its passage out of the stomach.
The non-drug medical management of obesity is where there is a package of familiar measures including diet, exercise, behaviour modification, and various forms of psychological support are all taken into account (Watts, Geoff 2012). Studies have shown that single figure percentage weight losses can be achieved and maintained with these measures, but not without the commitment on the part of the patient.
New treatments are essentially for future human health, to be able to help people who have become overweight. I guess we should stay tuned to see exactly what will happen in the future and whether it will really help or not.
Watts, G. 2012, “The future of obesity treatment: What can drugs and surgery offer?”, BMJ (Online), vol. 344, no. 7844, pp. 20-21. BMJ 2012;344:e1011
Wyatt, H.R. 2013, “Update on treatment strategies for obesity”, Journal of Clinical Endocrinology and Metabolism, vol. 98, no. 4, pp. 1299-1306. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615205/
Rodgers, R.J., Tschöp, M.H. & Wilding, J.P.H. 2012, “Anti-obesity drugs: Past, present and future”, DMM Disease Models and Mechanisms, [online] vol. 5, no. 5, pp. 621-626. http://dmm.biologists.org/content/5/5/621
McGavigan, A.K. & Murphy, K.G. 2012, “Gut hormones: the future of obesity treatment?”, British Journal of Clinical Pharmacology, vol. 74, no. 6, pp. 911-919. [online]http://onlinelibrary.wiley.com.ezproxy.mmu.ac.uk/doi/10.1111/j.1365-2125.2012.04278.x/full –
Bret S. Stetka, MD; WebMD Editors, March 30, 2015 [online]http://www.medscape.com/features/slideshow/future-of-health/obesity#4 –
Picture 1 – Bloomionhealth.org.2013 Obesity and Type2 Diabetes [online]http://bloominhealth.org.uk/obesity-and-type2-diabetes/
Picture 2 – Ethicon US, LLC. 2010 – 2015, Obesity, the Metabolic Disease [online] [Last updated December 15 2015]http://www.ethicon.com/healthcare-professionals/specialties/obesity/obesity-overview
Picture 3 -Richard Moss, November 2014. Hereditary gut microbes found to influence weight gain. [online] http://www.gizmag.com/hereditary-gut-microbes-obesity/34661/