Table of Contents
obesity and weight management
- cardiovascular disease:
- in white Causasians, cardiovascular risk increases by 13% for every 5.2 kg/m2 increase in women and 4.3 kg/m2 in men above an optimum level of 22-23 kg/m2 and, compared to women and men with waist circumferences of 74 and 83 cm respectively, the CVD risk increased by 16% in women and 10% in men for every 12.6 cm and 11.4 cm increase in waist circumference for women and men respectively.1)
- insulin resistance
- high sugar or fructose diet
- small intakes of sucrose or fructose are converted to glucose by enterocytes in the small bowel which is then metabolised by the whole body as needed
- excessive intakes of sucrose or fructose results in fructose being absorbed into the circulation and then it must be metabolised into fat primarily within the liver
- mental health issues
- medical iatrogenic risks
- vascular access issues
- pressure sores
- complexity of medical and surgical procedures increases
- ultrasound not as readily diagnostic
5-HT2C selective agonists
- lorcaserin is a selective 5-HT2C agonist with 15x more activity than on 5-HT2A receptors, and 100x more activity than on 5-HT2B receptors
- under trial for obesity management in 20102) - appears to reduce weight by ~6kg in 1 year compared with 2kg for a placebo with almost 50% of patients losing at least 5% body weight compared with only 20% of those on placebo.
GIT biome supplements
- Akkermansia muciniphila appears to improve pre-diabetes and reduce weight in an initial study 3)
other drugs which have been tried but adverse effects generally outweigh benefits
non-selective serotonin agonists
- fenfluramine and dexfenfluramine was approved for Mx of obesity in the USA by FDA in 1973 and 1996 respectively
- both were withdrawn in 1997 after they were found to cause serotonin associated cardiac valvulopathy which is thought to be due to agonism of 5-HT2B receptors, and is similar to that seen in carcinoid heart disease and ergot-alkaloid induced heart disease.
- rimonabant was withdrawn from the market in Europe because of an increased risk of depression, anxiety and suicidal ideation.
- the serotonin and noradrenaline reuptake inhibitor, sibutramine, was removed from the European market after a 100,000 patient, 6-year SCOUT study showed an increased risk of serious nonfatal cardiovascular events such as stroke or heart attack.
gastric laparoscopic banding (lap banding)
NEJM July 2010 363:3
obesity.txt · Last modified: 2023/03/22 22:15 by gary1