Progress in Pharmacotherapy for Obesity

Yanovski, Susan Z.; Yanovski, Jack A.

doi:10.1001/jama.2021.9486

Cited by 48 publications

(41 citation statements)

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“…For an individual patient, the selection of an obesogenic versus a nonobesogenic medication within a therapeutic class may be influenced by health care provider and patient awareness of the obesogenic properties of medications, availability of nonobesogenic options, potential impact of weight gain on the patient's health, relative efficacy and side effects of obesogenic and nonobesogenic options, and medication cost (6,13,(33)(34)(35)(36). Certain nonobesogenic alternatives, such as the antidepressant bupropion (in combination with naltrexone) (37), the anticonvulsant topiramate (in combination with phentermine) (38), and the antidiabetics liraglutide and semaglutide (39), are approved by the Food and Drug Administration for weight loss.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Use of prescription medications associated with weight gain among US adults, 1999‐2018: A nationally representative survey

Hales

Ogden

et al. 2021

Obesity

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Objective: This study aimed to evaluate trends in the use of obesogenic medications among adults.Methods: Cross-sectional data on adults aged ≥20 years are from the 1999 to 2018 National Health and Nutrition Examination Survey (n = 52,340). Obesogenic medications were defined according to the 2015 Endocrine Society guidelines on the pharmacological management of obesity. Weight status was categorized according to BMI.Trends in prior 30-day use were evaluated. Results:In NHANES 2017-2018, 20.3% of US adults used an obesogenic medication.Beta-blockers (9.8%) and antidiabetics (5.7%) were the most common; antipsychotics (1.0%) were the least common. Most common indications were disorders of glucose metabolism, hypertension, neuralgia or neuritis, heart disease, and musculoskeletal pain and/or inflammation. From 1999 to 2018, the proportional use of obesogenic medications increased for anticonvulsants (34.4% to 55.0%) but decreased for antidepressants (32.1% to 18.8%), antidiabetics (82.9% to 52.5%), and beta-blockers (83.9% to 80.7%). The proportional use of obesogenic medications was not associated with weight status, except for antipsychotics.Conclusions: Use of obesogenic medications was common. Differences in the proportional use of obesogenic medication may reflect changing availability of obesogenic versus nonobesogenic medications over time. The decision to prescribe a nonobesogenic alternative, if one exists, is guided by weighing the risks and benefits of available treatments.

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Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Use of prescription medications associated with weight gain among US adults, 1999‐2018: A nationally representative survey

Hales

Ogden

et al. 2021

Obesity

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“…Therefore, an early intervention against obesity or overweight in male populations suffering from infertility is crucial. However, even with several drugs against obesity being currently approved for marketing or in clinical trials, they are more often developed for weight loss in large weight groups; thus, their safety and efficacy are yet to be proven ( Yanovski and Yanovski, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Hua-Tan-Sheng-Jing Decoction Treats Obesity With Oligoasthenozoospermia by Up-Regulating the PI3K-AKT and Down-Regulating the JNK MAPK Signaling Pathways: At the Crossroad of Obesity and Oligoasthenozoospermia

et al. 2022

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Background: Oligoasthenozoospermia is the leading cause of male infertility, seriously affecting men’s health and increasing the societal medical burden. In recent years, obesity-related oligoasthenozoospermia has attracted increased attention from researchers to find a cure. This study aimed to evaluate the efficacy of Hua-Tan-Sheng-Jing decoction (HTSJD) in treating obesity with oligoasthenozoospermia, determine its active ingredients and identify its mechanism of action.Methods: The ingredients of HTSJD were determined by combining the ultra-performance liquid chromatography with mass spectrometry (UPLC-MS/MS) and systems pharmacology approach. The common pathogenesis of obesity and oligoasthenozoospermia and the potential mechanism of HTSJD against obesity with oligoasthenozoospermia were obtained through target fishing, network construction, and enrichment analyses. Further, molecular docking of the key ingredients with the upstream receptors of the key signaling pathways of the potential mechanism was used to predict their affinity. Finally, high-fat-induced obesity with oligoasthenozoospermia rat model was constructed to determine the effects of HTSJD on semen concentration, sperm motility, body weight, and serum lipid metabolism. The key proteins were validated by immunohistochemistry (IHC).Results: A total of 70 effective components and 847 potential targets of HTSJD (H targets) were identified, of which 743 were common targets related to obesity and oligoasthenozoospermia (O-O targets) mainly enriched in the pathways related to inflammation, oxidative stress and hormone regulation. Finally, 143 common targets (H-O-O targets) for HTSJD against obesity with oligoasthenozoospermia were obtained. Combining the hub genes and the results of Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of H-O-O targets, PI3K-AKT and MAPK signaling pathways were identified as the key pathways. Molecular docking results showed that Diosgenin, Kaempferol, Quercetin, Hederagenin, Isorhamnetin may act on the related pathways by docking EGFR, IGF1R and INSR. The animal-based in vivo experiments confirmed that HTSJD improves the sperm quality of high-fat diet-fed rats by reducing their body weight and blood lipid levels, influencing the PI3K-AKT and MAPK signaling pathways and altering the corresponding protein expressions.Conclusion: HTSJD treats obesity with oligoasthenozoospermia by up-regulating the PI3K-AKT signaling pathway and down-regulating the MAPK signaling pathway, which are at the crossroad of obesity and oligoasthenozoospermia.

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“…In general, reduced efficacy, safety problems, reluctance from patients and doctors, and lack of compensation by insurance companies, have reduced their spread. In addition, only in recent years, treatments that appear effective and safe have been approved, but unfortunately are also expensive [12,33].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Management in Bariatric Surgery Patients

Deledda

Pintus²,

Loviselli

et al. 2021

IJERPH

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The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

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Progress in Pharmacotherapy for Obesity

Abstract: This Viewpoint discusses the potential that newer antiobesity medications can provide for greater weight loss efficacy with an acceptable safety profile, including those with novel “twincretin” mechanisms of action.

Cited by 48 publications

References 10 publications

Use of prescription medications associated with weight gain among US adults, 1999‐2018: A nationally representative survey

Use of prescription medications associated with weight gain among US adults, 1999‐2018: A nationally representative survey

Hua-Tan-Sheng-Jing Decoction Treats Obesity With Oligoasthenozoospermia by Up-Regulating the PI3K-AKT and Down-Regulating the JNK MAPK Signaling Pathways: At the Crossroad of Obesity and Oligoasthenozoospermia

Nutritional Management in Bariatric Surgery Patients

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