Tratamento farmacológico da obesidade: a perspectiva da saúde pública

Abstract

EDITORIALDuring the past 30 years, prevalence of overweight (body mass index -BMI > 25kg/m 2 ) and obesity (BMI > 30kg/m 2 ) has dramatically risen worldwide. Since excess of weight contributes to the development and worsening of chronic illnesses such as type-2 diabetes, hypertension, cardiovascular diseases, stroke, depression, several types of cancer and other conditions, the prevention and effective treatment of obesity are expected to have a significant impact on morbidity, mortality, quality of life and cost of health care. The treatment of obesity is intended to prevent or attenuate morbidities associated with excess of weight, and not only to reduce weight or to achieve the patient's "ideal" body weight. Dieting and physical exercise are first-choice therapeutic options for obesity. It is generally agreed that pharmacological therapies, always alongside dieting and exercise, should be reserved for obese patients who had failed to respond to behavioral approaches alone. Nonetheless, pharmacological treatment of obesity has yielded disappointing results so far. A number of anti-obesity drugs (amphetamine-like agents, fenfluramine-derivatives, rimonabant, and others) were withdrawn from the market due to a clearly unfavorable risk to benefit ratio. Moreover, long-term effectiveness of appetite suppressants is at best questionable. Although causing weight loss during the first weeks of treatment, body weight reduction attributable to these medications (i.e., the weight loss in excess of that achieved with diet and exercise alone) is in general modest, and a partial regain of weight occurs when anorexic drugs are used for periods longer than one year. In almost all cases, weight loss achieved with appetite suppressants is totally regained when drug therapy is discontinued. Since obesity is a chronic condition, and body weight is regained upon drug discontinuation, patients are expected to take these medicines for years, or even for the rest of their lives. It is believed that even modest weight losses (5-10%) achieved with diets and exercises ameliorate obesity co-morbidities. Modest weight losses obtained by means of appetite suppressants, however, do not necessarily translate into long-term health benefits, i.e., into reduction of morbidity and mortality associated with overweight. The lack of long-term health benefits of an anorexic drug was recently revealed by a post-marketing 5-year clinical study (SCOUT -Sibutramine Cardiovascular Outcomes Trial) involving 10,744 obese patients with preexisting cardiovascular disease, type-2 diabetes or both. The SCOUT study showed that sibutramine increased risks of cardiovascular diseases (heart attack and strokes) instead of reducing them as expected. So far no controlled and randomized clinical study, with a sufficiently large number of patients, has demonstrated that other anorexic drugs produce long-term health benefits. After 13 years in the market, sibutramine was banned in the USA, Europe and most countries, where Orlistat, an inhibitor of pancreatic lipase th...

Atividade física, nutrição, farmacoterapia; a obesidade e seus tratamentos: uma revisão da literatura

“…Os tratamentos farmacológicos, sempre aliados à dieta e a exercícios, devem ser reservados para os pacientes obesos que não responderam às abordagens comportamentais apenas. Em quase todos os casos, a perda de peso alcançada com inibidores de apetite é revertida quando o medicamento é interrompido 23 . Como a obesidade é uma condição crônica, e o peso é recuperado com a interrupção do fármaco, é provável que os pacientes tomem esses medicamentos por anos, ou mesmo ao longo de suas vidas 23 .…”

Atividade física, nutrição, farmacoterapia; a obesidade e seus tratamentos: uma revisão da literatura

“…Em qualquer discussão sobre o uso racional de medicamentos antiobesidadeé importante entender alguns conceitos 22 Os tratamentos farmacológicos, sempre aliados à dieta e a exercícios, devem ser reservados para os pacientes obesos que não responderam às abordagens comportamentais apenas. Em quase todos os casos, a perda de peso alcançada com inibidores de apetite é revertida quando o medicamento é interrompido 23 . Como a obesidade é uma condição crônica, e o peso é recuperado com a interrupção do fármaco, é provável que os pacientes tomem esses medicamentos por anos, ou mesmo ao longo de suas vidas 23 .…”

“…Em quase todos os casos, a perda de peso alcançada com inibidores de apetite é revertida quando o medicamento é interrompido 23 . Como a obesidade é uma condição crônica, e o peso é recuperado com a interrupção do fármaco, é provável que os pacientes tomem esses medicamentos por anos, ou mesmo ao longo de suas vidas 23 .…”

A randomized trial on the effects of CitrusiM® (Citrus sinensis (L.) Osbeck dried extract) on body composition

“…For weight reduction, the WHO advises reducing carbohydrate and fat intake and increasing intake of vegetables, fruits, and fiber, as well as regular physical exercise [1]. However, some patients do not respond to such a strategy, and therefore pharmacological treatment may be used as a complement to the nutritional re-education [1,5].…”