Velazquez Amanda, Apovian Caroline M
Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA -
Minerva Endocrinol. 2018 Sep;43(3):356-366. doi: 10.23736/S0391-1977.17.02654-2. Epub 2017 Apr 28.
Current management of obesity includes three main arms: behavioral modification, pharmacologic therapy, and bariatric surgery. Decades prior, the only pharmacological agents available to treat obesity were approved only for short-term use (≤12 weeks) by the Food and Drug Administration (FDA). However, in the last several years, the FDA has approved several medications for longer term treatment of obesity. This highlights the important progression that we, as a society, better appreciate now the chronicity and complexity of obesity as a disease. Also, availability of more medication options gives healthcare providers more possibilities to consider in the management of obesity. Medications for obesity can be simply categorized as FDA approved short-term use (diethylproprion, phendimetrazine, benzphetamine, and phentermine) and long-term use (orlistat, phentermine/topiramate ER, lorcaserin, naltrexone/bupropion ER and liraglutide). Additionally, type 2 diabetes (T2DM) is commonly seen in patients with obesity and necessitates consideration of pharmacological options that do not hinder patients' weight loss. Finally, weight-centric prescribing is also an important component to pharmacological management of obesity. It warrants that healthcare providers thoroughly review their patients' medication lists to determine if any of these agents could be contributing to weight gain.
行为矫正、药物治疗和减肥手术。几十年前，美国食品药品监督管理局（FDA）批准的仅有的用于治疗肥胖症的药物仅适用于短期使用（≤12周）。然而，在过去几年中，FDA已批准了几种用于肥胖症长期治疗的药物。这凸显了一个重要的进展，即作为一个社会群体，我们现在能更好地认识到肥胖症作为一种疾病的慢性和复杂性。此外，更多药物选择的出现为医疗保健提供者在肥胖症管理方面提供了更多可考虑的可能性。治疗肥胖症的药物可简单分为FDA批准的短期使用药物（二乙丙胺苯丙酮、苯双甲吗啉、苄非他明和苯丁胺）和长期使用药物（奥利司他、苯丁胺/托吡酯缓释剂、氯卡色林、纳曲酮/安非他酮缓释剂和利拉鲁肽）。此外，2型糖尿病（T2DM）在肥胖症患者中很常见，因此需要考虑使用不妨碍患者体重减轻的药物选择。最后，以体重为中心的处方也是肥胖症药物治疗的一个重要组成部分。这就要求医疗保健提供者彻底审查患者的用药清单，以确定这些药物中是否有任何一种可能导致体重增加。
