Department of Internal Medicine, University of Oklahoma - Tulsa, Tulsa, Oklahoma, USA.
Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.
Obes Rev. 2024 May;25(5):e13709. doi: 10.1111/obr.13709. Epub 2024 Feb 6.
Glucagon-like peptide 1 (GLP-1) receptor agonists are revolutionizing obesity and type 2 diabetes treatment, delivering remarkable weight loss outcomes. These medications, leveraging the effects of the insulin-regulating hormone GLP-1 via actions on peripheral and central nervous system targets, have raised hopes with their bariatric surgery-rivaling results. However, questions remain about their long-term safety and efficacy. Drawing from our expertise in obesity medicine and psychiatry, we reflect upon our experiences with the clinical use of these medications and delve into the nuanced challenges and risks they pose, particularly for those prone to disordered eating or those diagnosed with rare genetic diseases of obesity. We contend that effectively managing weight loss within this "danger zone" necessitates (1) proactive screening and continuous monitoring for disordered eating, (2) vigilant monitoring for appetite-related maladaptive responses, including food aversion and dehydration, and (3) ongoing assessment for broader health impacts. A multifaceted, interdisciplinary approach that melds medical, psychological, dietary, and behavioral strategies is crucial to delivering tailored and thorough care to each patient.
胰高血糖素样肽 1（GLP-1）受体激动剂正在彻底改变肥胖和 2 型糖尿病的治疗方法，带来显著的减肥效果。这些药物通过作用于外周和中枢神经系统靶点来利用调节胰岛素的激素 GLP-1 的作用，其减肥手术效果堪比手术的结果燃起了人们的希望。然而，关于它们的长期安全性和疗效仍存在疑问。我们凭借在肥胖医学和精神病学方面的专业知识，反思了我们在这些药物的临床应用方面的经验，并深入探讨了它们所带来的细微挑战和风险，特别是对于那些容易出现饮食失调或患有罕见肥胖遗传疾病的人。我们认为，要在这个“危险区”内有效地管理体重减轻，需要（1）主动筛查和持续监测饮食失调，（2）警惕与食欲相关的适应不良反应，包括食物厌恶和脱水，以及（3）持续评估更广泛的健康影响。一种融合了医学、心理学、饮食和行为策略的多方面、跨学科方法对于为每位患者提供量身定制和全面的护理至关重要。
