Son Jang Won, Kim Sungrae
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Diabetes Metab J. 2020 Dec;44(6):802-818. doi: 10.4093/dmj.2020.0258. Epub 2020 Dec 23.
Obesity is among the leading causes of morbidity and mortality worldwide and its prevalence continues to increase globally. Because obesity is a chronic, complex, and heterogeneous disease influenced by genetic, developmental, biological, and environmental factors, it is necessary to approach obesity with an integrated and comprehensive treatment strategy. As it is difficult to achieve and sustain successful long-term weight loss in most patients with obesity through lifestyle modifications (e.g., diet, exercise, and behavioral therapy), pharmacological approaches to the treatment of obesity should be considered as an adjunct therapy. Currently, four drugs (orlistat, naltrexone extended-release [ER]/bupropion ER, phentermine/topiramate controlled-release, and liraglutide) can be used long-term (>12 weeks) to promote weight loss by suppressing appetite or decreasing fat absorption. Pharmacotherapy for obesity should be conducted according to a proper assessment of the clinical evidence and customized to individual patients considering the characteristics of each drug and comorbidities associated with obesity. In this review, we discuss the mechanisms of action, efficacy, and safety of these available long-term anti-obesity drugs and introduce other potential agents under investigation. Furthermore, we discuss the need for research on personalized obesity medicine.
肥胖是全球发病和死亡的主要原因之一，其患病率在全球范围内持续上升。由于肥胖是一种受遗传、发育、生物学和环境因素影响的慢性、复杂且异质性疾病，因此有必要采用综合全面的治疗策略来应对肥胖问题。由于大多数肥胖患者通过生活方式改变（如饮食、运动和行为疗法）难以实现并维持长期成功减重，肥胖的药物治疗应被视为辅助疗法。目前，有四种药物（奥利司他、纳曲酮缓释剂/安非他酮缓释剂、芬特明/托吡酯控释剂和利拉鲁肽）可长期（>12周）使用，通过抑制食欲或减少脂肪吸收来促进体重减轻。肥胖的药物治疗应根据对临床证据的适当评估进行，并根据每种药物的特点以及与肥胖相关的合并症为个体患者量身定制。在本综述中，我们讨论了这些现有的长期抗肥胖药物的作用机制、疗效和安全性，并介绍了其他正在研究的潜在药物。此外，我们讨论了个性化肥胖医学研究的必要性。
