Tailoring pharmacotherapy to specific eating behaviours in obesity: Can recommendations for personalised therapy be made from the current data?

Abstract

Pharmacotherapy provides an adjunct to behaviour modification in the management of obesity. There are a number of new drug therapies purportedly targeting appetite; liraglutide, and bupropion/naltrexone, which are European Medicines Agency and US Food and Drug Administration (FDA) approved, and lorcaserin and phentermine/topiramate, which have FDA approval only. Each of the six drugs, used singly or in combination, has distinct pharmacological, and presumably distinct behavioural, mechanisms of action, thus the potential to provide defined therapeutic options to personalise the management of obesity. Yet, with regard to pharmacotherapy for obesity, we are far from true personalised medicine. We review the limited mechanistic data with four mono and combination pharmacotherapies, to assess the potential for tailoring their use to target specific obesogenic behaviours. Potential treatment options are considered, but in the absence of adequate research in respect to effects of these drugs on eating behaviour, neural activity and psychological substrates that underlie poorly controlled eating, we are far from definitive therapeutic recommendations. Specific mechanistic studies and broader behavioural phenotyping, possibly in conjunction with pharmacogenetic research, are required to characterise responders for distinct pharmacotherapeutic options.

Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

“…These include prolonged action compared with gut‐derived GLP‐1; favorable effects on weight loss, diabetes, and cardiovascular disease; and limited contraindications for use. Gut‐derived GLP‐1 is quickly degraded by dipeptidyl‐peptidase‐4 (DPP‐4) enzymes; however, pharmacologic GLP‐1‐RAs are designed to resist this degradation and may exert central nervous system effects via vagal nerve afferents and crossing the blood–brain barrier to alter calorie intake (28). While other AOMs also work in the central nervous system to reduce appetite (10), glycemic and cardiovascular benefits increase the appeal of GLP‐1‐RA therapies in this population who are at greater risk of metabolic and cardiovascular complications of excess body weight, especially relative to stimulant‐based AOM regimens.…”

Exploring the munchies: An online survey of users’ experiences of cannabis effects on appetite and the development of a Cannabinoid Eating Experience Questionnaire

“…Human appetite involves a complex interplay between motivation, reward and behavioural control (Roberts et al, 2017) and it is now clear the endocannabinoid system is heavily involved in hunger and food reward. Thus, our data suggest that cannabis-induced hyperphagia is produced by natural adjustments in endocannabinoid-mediated hunger, sensory and food-reward processes, leading to enhanced appetite and a heightened appreciation of food.…”

Comprehensive Review of Current and Upcoming Anti-Obesity Drugs

“…Furthermore, pharmacogenetic and mechanistic studies to confirm the effects of drugs on feeding behavior and reward processing would allow the further characterization of good responders to various anti-obesity drugs [ 77 ].…”