A systematic review and mixed treatment comparison of pharmacological interventions for the treatment of obesity

Gray, Laura J.; Cooper, Nicola J.; Dunkley, Alison J.; Warren, FC; Ara, Roberta; Abrams, Keith R.; Davies, Melanie J.; Khunti, Kamlesh; Sutton, Alex J.

doi:10.1111/j.1467-789x.2011.00981.x

Cited by 44 publications

(47 citation statements)

References 26 publications

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“…218,226 The role of intentional weight loss in obesity as a means of preventing CVD has been the subject of multiple previous studies and reviews 218,219,222,[226][227][228][229] and is beyond the scope of this document. The recent 2013 AHA/ACC/The Obesity Society "Guideline for the Management of Overweight and Obesity in Adults" underlines the importance of the prevention and treatment of overweight and obesity on risk factors for CVD and type 2 diabetes mellitus, as well as CVD morbidity and mortality, but did not have specific comments on the prevention of HF or treatment of obesity in patients with HF.…”

Section: Treatment Of Obesity In Patients Without Established Hf and mentioning

confidence: 99%

“…In this study, the intervention group did not have weight loss, and there was no significant difference between the intervention and control groups in terms of metabolic, biomarker, or functional parameters. 227,240 In both studies, the intervention groups had a mean BMI >35 kg/m 2 . Neither study reported adverse events, however, suggesting that monitored, healthy dietary intervention programs aiming to achieve weight loss are safe in obese patients with HF.…”

Section: Dietary Interventionmentioning

confidence: 99%

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Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

349

220

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CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

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Section: Treatment Of Obesity In Patients Without Established Hf and mentioning

confidence: 99%

Section: Dietary Interventionmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

349

220

View full text Add to dashboard Cite

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“…10,11,13 Past pharmaceutical approaches have been equally disappointing, both in terms of modest treatment effects and unacceptable side effects. 14,15 At present, the most successful treatments for obesity are surgical procedures, still with limited application for most obese and overweight people. 14,16 The classic twin adoption studies of Stunkard showed that both fatness and thinness were highly heritable and not influenced by the adopting family members' adiposity.…”

Section: Background and Aimsmentioning

confidence: 99%

“…14,15 At present, the most successful treatments for obesity are surgical procedures, still with limited application for most obese and overweight people. 14,16 The classic twin adoption studies of Stunkard showed that both fatness and thinness were highly heritable and not influenced by the adopting family members' adiposity. 17 Numerous genetic studies since, in a variety of populations and using various measures of adiposity, have been consistent with those fundamental findings.…”

Section: Background and Aimsmentioning

confidence: 99%

Future management of human obesity: understanding the meaning of genetic susceptibility

Jenkins¹,

Campbell²

2014

AGG

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Gene-environment interactions are central to the expression of obesity. The condition is strongly heritable (ie, genetic), and most of the variation in obesity levels between countries and between individuals can be explained by the effects of obesogenic environments on individual genetic susceptibilities. The nature of the obesogenic environmental influences is not clear in detail, but they correlate closely with measures of affluence. The causes of variation in genetic susceptibility are also not clearly defined, but their general nature has become clearer. The failure of genome-wide association studies or large linkage studies to identify or replicate causative genetic variants, together with the segregation of obesity-related traits in families, implicates a heterogenetic mechanism in which rare, dominantly or additively expressed genetic variants are responsible for most of common obesity. The search for rare causative variants continues with some successes, but those identified contribute very little to the overall burden and, assuming heterogenetics, there are many more to find. The time when genomic risk factors provide more information than do currently available markers, such as family history, is a long way off. Genomic studies to date have contributed little, if anything, to the prevention and treatment of common obesity and its associated disorders. This contrasts with the obvious and immediate potential implications of the well-established overall genetic basis of obesity, which have not yet been exploited in the clinical or public health arenas. Genomic studies, which have helped to define the genetic basis of common obesity mainly by exclusion, will in the future play an increasingly important role in understanding and managing obesity, but only with parallel studies of the physiological, behavioral, and economic influences. Keywords: obesity phenotypes, obesogenic environment, genomics, pathophysiology, treatment, prevention Background and aimsAccording to the World Health Organization projections, by 2015 about 2.3 billion adults in the world will be overweight and over 700 million will be obese, and economic costing predicts that obesity-related expenditure in USA will approach US$100 billion per annum.1 It is now widely, if not universally, accepted that the rising national and global prevalence of overweight and obesity since the 1980s can be understood as the effects of increasingly obesogenic environments (OEs), which are correlated with measures of affluence and food availability, 2 in genetically predisposed individuals. 3,4 Obesity is assessed by the body mass index (BMI, kg/m 2 ) in most epidemiological and genetic studies, often together with measures of central fat distribution such as waist circumference because of adverse metabolic and health associations. However, neither BMI nor other anthropometric measurements are by themselves sufficiently accurate

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“…The process is undergoing a revaluation, showing that obese individuals must accomplish appropriate steps to weight loss, under medical supervision (Gray et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional study of the dispensation of synthetic anorectic drugs in community pharmacies in the city of Cruz Alta - State of Rio Grande do Sul

Navarini

Deuschle

Deuschle³

2014

Braz. J. Pharm. Sci.

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Obesity is defined as the excess adipose tissue in the body. Drugs responsible for inhibiting the appetite are called anorectics or appetite suppressants. Sibutramine, fenproporex and amfepramone belongs to this class, and are capable of causing physical or psychological dependence. The aim of this study was to evaluate the frequency of prescriptions for appetite suppressants in community pharmacies at Cruz Alta, State of Rio Grande do Sul, Brazil. The sales of fenproporex, amfepramone and sibutramine in the months of September, October and November 2010 and April, May and June 2011 were compared. It was observed that the most commonly dispensed anorectic in the three community pharmacies analyzed was sibutramine. In the months of September, October and November 2010, consumption was higher, with sibutramine achieving 40.3% of overall sales, amfepramone 21% and, finally, fenproporex, 7.9%. The consumption of appetite suppressants was more prevalent in females, who represented 82% of total. The results suggested the existence of high consumption of anorectics, possibly related to the current concern with aesthetic standards, which emphasizes the importance of strict control over the marketing of these substances.

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A systematic review and mixed treatment comparison of pharmacological interventions for the treatment of obesity

Cited by 44 publications

References 26 publications

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Future management of human obesity: understanding the meaning of genetic susceptibility

Cross-sectional study of the dispensation of synthetic anorectic drugs in community pharmacies in the city of Cruz Alta - State of Rio Grande do Sul

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