Weight Reduction Pharmacotherapy

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The purpose of weight loss and weight maintenance is to reduce health risks. If weight is regained, health risks increase once more. The majority of persons who lose weight regain it, so the challenge to the patient and the practitioner is to maintain the weight loss. Because of the tendency to regain weight after weight loss, the use of long-term medication to aid in the treatment of obesity may be indicated in some carefully selected patients.

One weight loss drug is sibutramine. It has norepi-nephrine and serotonin effects. Another new agent, orlistat, has a different mechanism of action, the blockage of fat absorption. Very few trials longer than 6 months have been done with any drug. These drugs are effective but modest in their ability to produce weight loss. Net weight loss attributable to drugs generally has been reported to be in the range of 2-10 kg (4.4-22 lb), although some patients lose significantly more weight. It is not possible to predict how much weight an individual may lose. Most of the weight loss usually occurs in the first 6 months of therapy.

With sibutramine there is a tendency for increased blood pressure and pulse rate. People with a history of high blood pressure, CHD, congestive heart failure, arrhythmias, or stroke should not take sibutramine, and all patients taking the medication should have their blood pressure monitored on a regular basis. With or-listat, there is a possible decrease in the absorption of fat-soluble vitamins; overcoming this may require vitamin supplementation.

Given that adverse events may occur with drug therapy, it seems wise, until further safety data are available, to use weight loss drugs cautiously. Furthermore, drugs should be used only as part of a comprehensive program that includes behavior therapy, diet, and physical activity. Appropriate monitoring for side effects must be continued while drugs are part of the regimen. Patients will need to return for follow-up in 24 weeks, then monthly for 3 months, and then every 3 months for the first year after starting the medication. Drugs should be used only in the context of a long-term treatment strategy.

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