Korean J Fam Pract 2020; 10(2): 77-86  https://doi.org/10.21215/kjfp.2020.10.2.77
Obesity Treatment in Ambulatory Care Focused on Pharmacotherapy
Su Hwan Cho1, Kyoung-Kon Kim2,*
1VIP Healthcare Center, Gachon University Gil Medical Center, 2Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
Kyoung-Kon Kim
Tel: +82-32-458-2778, Fax: +82-32-460-2391
E-mail: zaduplum@aim.com
ORCID: http://orcid.org/0000-0003-0374-2571
Received: March 27, 2020; Accepted: April 2, 2020; Published online: April 20, 2020.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Obesity is a chronic relapsing disease associated with cardiovascular disease and cancer with a growing incidence. Since obesity is a complex disease that is affected by a variety of factors, including social, cultural, and environmental factors, it should be approached by establishing an integrated and comprehensive treatment strategy. It is difficult to achieve a sufficient amount of weight loss in most obese patients through lifestyle interventions alone, so pharmacotherapy in primary care should be actively considered as an additional treatment. Currently, there are four drugs that can be used for long-term weight management in Korea: orlistat, naltrexone/bupropion, phentermine/topiramate, and liraglutide. Sympathomimetics, such as phentermine, diethylpropion, phendimetrazine, and mazindol, can only be used for short-term treatment. These drugs can induce weight loss by suppressing appetite or inhibiting fat absorption in the gut. The prescription of such drug treatments should be based on evidence-based clinical care and tailored to the patient. Patient-tailored obesity drug treatments should be performed taking into consideration the advantages, side effects, and safety issues of each drug. Considering that obesity is a chronic disease that must be controlled for a lifetime, obese patients should be guided by clinicians to maintain their weight sustainably by setting common and realistic goals.
Keywords: Obesity; Drug Therapy; Weight Loss; Anti-Obesity Agents; Ambulatory Care
References
  1. Park JH, Yoon SJ, Lee H, Jo HS, Lee SI, Kim Y, et al. Burden of disease attributable to obesity and overweight in Korea. Int J Obes (Lond) 2006; 30: 1661-9.
    Pubmed CrossRef
  2. Korean Society for the Study of Obesity, National Health Insurance Service. 2019 Obesity Fact Sheet. Seoul: Korean Society for the Study of Obesity;2019.
  3. Korean Society for the Study of Obesity, National Health Insurance Service. 2018 Obesity Fact Sheet. Seoul: Korean Society for the Study of Obesity;2018.
    CrossRef
  4. Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, et al. Gaps to bridge: misalignment between perception, reality and actions in obesity. Diabetes Obes Metab 2019; 21: 1914-24.
    Pubmed KoreaMed CrossRef
  5. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 2016; 22 Suppl 3: 1-203.
    Pubmed CrossRef
  6. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts 2015; 8: 402-24.
    Pubmed KoreaMed CrossRef
  7. Leslie WS, Hankey CR, Lean ME. Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review. QJM 2007; 100: 395-404.
    Pubmed CrossRef
  8. Blumenthal SR, Castro VM, Clements CC, Rosenfield HR, Murphy SN, Fava M, et al. An electronic health records study of long-term weight gain following antidepressant use. JAMA Psychiatry 2014; 71: 889-96.
    Pubmed CrossRef
  9. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015; 100: 342-62.
    Pubmed CrossRef
  10. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean Society for the Study of Obesity guideline for the management of obesity in Korea. J Obes Metab Syndr 2019; 28: 40-5.
    Pubmed KoreaMed CrossRef
  11. U.S. Food and Drug Administration (FDA). FDA requests the withdrawal of the weight-loss drug Belviq, Belviq XR (lorcaserin) from the market [Internet]. Silver Spring (MD): FDA; c2020 [cited 2020 Mar 23].
    Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market
  12. Bray GA, Ryan DH. Update on obesity pharmacotherapy. Ann N Y Acad Sci 2014; 1311: 1-13.
    Pubmed CrossRef
  13. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014; 311: 74-86.
    Pubmed KoreaMed CrossRef
  14. Colman E, Golden J, Roberts M, Egan A, Weaver J, Rosebraugh C. The FDA's assessment of two drugs for chronic weight management. N Engl J Med 2012; 367: 1577-9.
    Pubmed CrossRef
  15. Hauptman JB, Jeunet FS, Hartmann D. Initial studies in humans with the novel gastrointestinal lipase inhibitor Ro 18-0647 (tetrahydrolipstatin). Am J Clin Nutr 1992; 55(1 Suppl): 309S-13S.
    Pubmed CrossRef
  16. Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 2005; 293: 2873-83.
    Pubmed CrossRef
  17. Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155-61.
    Pubmed CrossRef
  18. Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ 2007; 335: 1194-9.
    Pubmed KoreaMed CrossRef
  19. Ballinger A, Peikin SR. Orlistat: its current status as an anti-obesity drug. Eur J Pharmacol 2002; 440: 109-17.
    Pubmed CrossRef
  20. Wang GJ, Volkow ND, Logan J, Pappas NR, Wong CT, Zhu W, et al. Brain dopamine and obesity. Lancet 2001; 357: 354-7.
    CrossRef
  21. Peciña S, Smith KS. Hedonic and motivational roles of opioids in food reward:implications for overeating disorders. Pharmacol Biochem Behav 2010; 97: 34-46.
    Pubmed CrossRef
  22. Koch M, Varela L, Kim JG, Kim JD, Hernández-Nuño F, Simonds SE, et al. Hypothalamic POMC neurons promote cannabinoid-induced feeding. Nature 2015; 519: 45-50.
    Pubmed KoreaMed CrossRef
  23. Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2010; 376: 595-605.
    CrossRef
  24. Apovian CM, Aronne L, Rubino D, Still C, Wyatt H, Burns C, et al. A ran domized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity (Silver Spring) 2013; 21: 935-43.
    Pubmed KoreaMed CrossRef
  25. Nissen SE, Wolski KE, Prcela L, Wadden T, Buse JB, Bakris G, et al. Effect of naltrexone-bupropion on major adverse cardiovascular events in overweight and obese patients with cardiovascular risk factors: a randomized clinical trial. JAMA 2016; 315: 990-1004.
    Pubmed CrossRef
  26. Nalpropion Pharmaceuticals, Inc. CONTRAVE (naltrexone HCl and bupropion HCl) prescribing information [Internet]. San Diego (CA): Nalpropion Pharmaceuticals, Inc.; 2014 [cited 2020 Mar 23].
    Available from: https://contravehcp.com/wp-content/uploads/member-content/Contrave_PI_MedGuide.pdf
  27. Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377: 1341-52.
    Pubmed CrossRef
  28. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA 2016; 315:2424-34.
    Pubmed KoreaMed CrossRef
  29. Margulis AV, Mitchell AA, Gilboa SM, Werler MM, Mittleman MA, Glynn RJ, et al. Use of topiramate in pregnancy and risk of oral clefts. Am J Obstet Gynecol 2012; 207: 405.e1-7.
    Pubmed KoreaMed CrossRef
  30. Torekov SS, Madsbad S, Holst JJ. Obesity - an indication for GLP-1 treatment? Obesity pathophysiology and GLP-1 treatment potential. Obes Rev 2011; 12: 593-601.
    Pubmed CrossRef
  31. Delgado-Aros S, Kim DY, Burton DD, Thomforde GM, Stephens D, Brinkmann BH, et al. Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans. Am J Physiol Gastrointest Liver Physiol 2002; 282: G424-31.
    Pubmed CrossRef
  32. Woods SC, D'Alessio DA. Central control of body weight and appetite. J Clin Endocrinol Metab 2008; 93(11 Suppl 1): S37-50.
    Pubmed KoreaMed CrossRef
  33. Holst JJ, Vilsbøll T, Deacon CF. The incretin system and its role in type 2 diabetes mellitus. Mol Cell Endocrinol 2009; 297: 127-36.
    Pubmed CrossRef
  34. Mentlein R. Dipeptidyl-peptidase IV (CD26)--role in the inactivation of regulatory peptides. Regul Pept 1999; 85: 9-24.
    CrossRef
  35. Barrera JG, Sandoval DA, D'Alessio DA, Seeley RJ. GLP-1 and energy balance:an integrated model of short-term and long-term control. Nat Rev Endocrinol 2011; 7: 507-16.
    Pubmed KoreaMed CrossRef
  36. Kastin AJ, Akerstrom V, Pan W. Interactions of glucagon-like peptide-1 (GLP-1) with the blood-brain barrier. J Mol Neurosci 2002; 18: 7-14.
    Pubmed CrossRef
  37. Secher A, Jelsing J, Baquero AF, Hecksher-Sørensen J, Cowley MA, Dalbøge LS, et al. The arcuate nucleus mediates GLP-1 receptor agonist liraglutidedependent weight loss. J Clin Invest 2014; 124: 4473-88.
    Pubmed KoreaMed CrossRef
  38. Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM, et al. Weight maintenance and additional weight loss with liraglutide after lowcaloriediet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond) 2013; 37: 1443-51.
    Pubmed CrossRef
  39. Davies M, Bode B, Kushner R, Lewin A, Skjøth TV, Jensen CB, et al. Liraglutide 3.0 mg for weight management in obese/overweight adults with Type 2 Diabetes: results from the SCALE diabetes 56-week randomized, doubleblind, placebo-controlled trial. Diabetol Stoffwechs 2015; 10: LB7.
    CrossRef
  40. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 2015; 373: 11-22.
    Pubmed CrossRef
  41. Blackman A, Foster GD, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond) 2016; 40: 1310-9.
    Pubmed KoreaMed CrossRef
  42. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311-22.
    Pubmed KoreaMed CrossRef
  43. Ministry of Food and Drug Safety. Pharmaceutical integrated information system [Internet]. Cheongju: Ministry of Food and Drug Safety; [cited 2020 Mar 18].
    Available from: https://nedrug.mfds.go.kr
  44. Wadden TA, Foreyt JP, Foster GD, Hill JO, Klein S, O'Neil PM, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring) 2011; 19: 110-20.
    Pubmed KoreaMed CrossRef
  45. Allison DB, Gadde KM, Garvey WT, Peterson CA, Schwiers ML, Najarian T, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring) 2012; 20: 330-42.
    Pubmed KoreaMed CrossRef
  46. Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr 2012; 95: 297-308.
    Pubmed KoreaMed CrossRef
  47. Winslow DH, Bowden CH, DiDonato KP, McCullough PA. A randomized, double-blind, placebo-controlled study of an oral, extended-release formulation of phentermine/topiramate for the treatment of obstructive sleep apnea in obese adults. Sleep 2012; 35: 1529-39.
    Pubmed KoreaMed CrossRef
  48. Hollander P, Gupta AK, Plodkowski R, Greenway F, Bays H, Burns C, et al. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care 2013; 36: 4022-9.
    Pubmed KoreaMed CrossRef
  49. Onakpoya IJ, Heneghan CJ, Aronson JK. Post-marketing withdrawal of antiobesity medicinal products because of adverse drug reactions: a systematic review. BMC Med 2016; 14: 191.
    Pubmed KoreaMed CrossRef

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives