Targets for medical therapy in obesity

Obesity has more than doubled since 1980 all over the world, and in the European perspective it does not seem to be better. Obesity-related diseases like diabetes, hypertension, coronary heart disease, stroke and hyperlipidemia are the main cause of mortality and morbidity in developed countries. These are the reasons for continuous search for efficient treatment of obesity. One of the options is medical therapy. Over history, many anti-obesity drugs were introduced and subsequently removed from the market due to various side effects. Unfortunately, there is still no ideal drug for the treatment of obesity, and the current ones are very strictly evaluated. The anti-obesity drug should target patients that have previously failed to lose weight with lifestyle interventions, with body mass index (BMI) ≥30, or those with BMI ≥27 plus concomitant obesity-related risk factors or diseases. The only drug currently approved in Europe is orlistat, a pancreatic lipase inhibitor. Sibutramine, an appetite suppressant (serotonin-norepinephrine reuptake inhibitor), has been off the market since 2010 due to cardiovascular side effects. There is a large group of drugs used for other indications with weight loss effects, e.g. incretin mimetics or analogues used in the treatment of diabetes type 2, topiramate used as an anticonvulsant, and fluoxetine and sertraline used in the treatment of depression.