Addiction Liability of Pharmacotherapeutic Interventions in Obesity

Abstract

Obesity and substance use disorders are rapidly growing problems throughout the world. Of the current mainstay therapies of diet, exercise, behavioral modification, surgery, and medications, drugs have the greatest risk for abuse and dependence. As each of these disorders share similar underpinnings mediated by the dopaminergic brain reward pathways, clinicians must seriously consider the safety of both the patient's physical and mental health when prescribing treatments. Specifically, balance and awareness of the factors involved in the variable abuse potentials of these prescribed medications is paramount. A cursory review of weight loss medications commonly used is performed with attention to FDA status, mechanism of action, and abuse potential. Concurrent strategies to minimize risk such as drug screening, ruling out doctor shopping, temporal considerations, monitoring for signs and symptoms of abuse and/or dependency, and a safety-tiered prescribing approach is also discussed in order to optimize best treatment practice. As the understanding of these disorders progresses along with the evolution of agreed nomenclature and awareness of compulsive behavioral disorders in general, greater safety and more appropriate interventions may be achieved. Further areas of research will help to elucidate nuances of the coocurrance and treatment of these disorders and perhaps guide drug research and development in the area of drug treatments of obesity.

Food Addiction and Obesity: Do Macronutrients Matter?

“…“Common hedonic mechanisms may therefore underlie obesity and drug addiction,” concluded Johnson and Kenny (2010). Addiction liability is being discussed inline with development of obesity pharmacotherapy (Greene et al, 2011). …”

Should pathological gambling and obesity be considered addictive disorders? A factor analytic study in a nationally representative sample

“…This debate is important because the nosological status of a disorder is an important determinant of its lines of research (Blanco et al, 2009; Moreyra et al, 2002), treatment models (Greene et al, 2011; Petry et al, 2006) and approaches to policy and funding for treatment and research (Petry and Blanco, 2013). …”