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Abdalla Ahmed MA, Ssemmondo E, Mark-Wagstaff C, Sathyapalan T. Advancements in the management of obesity: a review of current evidence and emerging therapies. Expert Rev Endocrinol Metab 2024; 19:257-268. [PMID: 38685693 DOI: 10.1080/17446651.2024.2347258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Obesity is the modern world's current epidemic, with substantial health and economic impact. This study aimed to provide a narrative overview of the past, currently available, and future treatment options that offer therapeutic and preventive advantages for obesity management. AREAS COVERED Historically, rimonabant, and lorcaserin, were approved and used for managing non-syndromic obesity. Currently, orlistat, naltrexone/bupropion, glucagon-like peptide-1 receptor agonist (GLP-1 RA), and a few promising therapeutic agents are under investigation, including retatrutide, cagrilintide and orforglipron, which show promising weight reduction effects. We have developed a search string of the Medical Subject Headings (MeSH), including the terms GLP-1 RAs, obesity, and weight loss. This string was then used to perform a systematic literature search in the database including PubMed, EMBASE, MEDLINE, and Scopus up to January 31st, 2024. EXPERT OPINION Managing obesity often requires medical interventions, particularly in cases of severe obesity or obesity-related comorbidities. Thus, it is important to approach obesity management holistically, considering individual needs and circumstances. In our opinion, consulting with healthcare professionals is crucial to developing a personalized plan that addresses both weight loss and overall health improvement.
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Affiliation(s)
- Mohammed Altigani Abdalla Ahmed
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
- Hull York Medical School, University of Hull, Hull, UK
| | - Emmanuel Ssemmondo
- Hull York Medical School, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital, NHS Trust, Hull, UK
| | - Charlotte Mark-Wagstaff
- Hull York Medical School, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital, NHS Trust, Hull, UK
| | - Thozhukat Sathyapalan
- Hull York Medical School, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital, NHS Trust, Hull, UK
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Roomy MA, Hussain K, Behbehani HM, Abu-Farha J, Al-Harris R, Ambi AM, Abdalla MA, Al-Mulla F, Abu-Farha M, Abubaker J. Therapeutic advances in obesity management: an overview of the therapeutic interventions. Front Endocrinol (Lausanne) 2024; 15:1364503. [PMID: 38715796 PMCID: PMC11074390 DOI: 10.3389/fendo.2024.1364503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/09/2024] [Indexed: 05/23/2024] Open
Abstract
Obesity has become a global epidemic in the modern world, significantly impacting the global healthcare economy. Lifestyle interventions remain the primary approach to managing obesity, with medical therapy considered a secondary option, often used in conjunction with lifestyle modifications. In recent years, there has been a proliferation of newer therapeutic agents, revolutionizing the treatment landscape for obesity. Notably, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, liraglutide, and the recently approved dual GLP-1/GIP RAs agonist tirzepatide, have emerged as effective medications for managing obesity, resulting in significant weight loss. These agents not only promote weight reduction but also improve metabolic parameters, including lipid profiles, glucose levels, and central adiposity. On the other hand, bariatric surgery has demonstrated superior efficacy in achieving weight reduction and addressing overall metabolic imbalances. However, with ongoing technological advancements, there is an ongoing debate regarding whether personalized medicine, targeting specific components, will shape the future of developing novel therapeutic agents for obesity management.
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Affiliation(s)
- Moody Al Roomy
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Kainat Hussain
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Hawraa M. Behbehani
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jenna Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Rayan Al-Harris
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Aishwarya Mariam Ambi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohammed Altigani Abdalla
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fahd Al-Mulla
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
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Shin D, Kwon J, Kang HS, Suh J, Lee E. The presence of unauthorized ingredients in dietary supplements: an analysis of the risk warning data in Korea. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2022.104462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abdalla MA, Deshmukh H, Atkin S, Sathyapalan T. A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome. Ther Adv Endocrinol Metab 2020; 11:2042018820938305. [PMID: 32670541 PMCID: PMC7338645 DOI: 10.1177/2042018820938305] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.
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Affiliation(s)
- Mohammed Altigani Abdalla
- Department of Academic Diabetes, Endocrinology
and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Harshal Deshmukh
- Department of Academic Diabetes, Endocrinology
and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Stephen Atkin
- School of Postgraduate Studies and Research,
RCSI Medical University of Bahrain, Kingdom of Bahrain
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Abuzzahab MJ, Roth CL, Shoemaker AH. Hypothalamic Obesity: Prologue and Promise. Horm Res Paediatr 2019; 91:128-136. [PMID: 30884480 DOI: 10.1159/000496564] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
Hypothalamic obesity (HO) frequently occurs following damage to the medial hypothalamic region, encompassing the arcuate nucleus, the paraventricular nucleus, the ventromedial nucleus, the dorsomedial nucleus, and the dorsal hypothalamic area, which are critically involved in the regulation of satiety and energy balance through neural and humoral connections. HO is most commonly described in the context of craniopharyngioma and its treatment, but it can also occur following other suprasellar tumors, radiation, trauma, or a surgical insult to the hypothalamus. A constellation of loss of satiety and a reduction of the metabolic rate, thermogenesis, and physical activity as well as increased vagal tone and hyperinsulinism with insulin and leptin resistance results in rapid weight gain due to a decreased energy expenditure and increased energy storage in adipose cells. To date, no viable long-term solution for HO has been found, due either to the requirement of intact hypothalamic pathways or to significant side effects. Newer therapeutic modalities focused on the unique pathophysiology of this condition offer potential for successful treatment. In this review, we describe the etiology of HO as well as past/current treatment approaches in the categories of hyperinsulinism, surgical approaches, and targeting energy expenditure/anorectic drugs. We conclude by providing an overview of the clinical trials currently underway.
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Affiliation(s)
| | - Christian L Roth
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ashley H Shoemaker
- Division of Endocrinology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Benefit-Risk Assessment of Obesity Drugs: Focus on Glucagon-like Peptide-1 Receptor Agonists. Drug Saf 2019; 42:957-971. [DOI: 10.1007/s40264-019-00812-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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You Y, Yuan X, Liu X, Liang C, Meng M, Huang Y, Han X, Guo J, Guo Y, Ren C, Zhang Q, Sun X, Ma T, Liu G, Jin W, Huang W, Zhan J. Cyanidin-3-glucoside increases whole body energy metabolism by upregulating brown adipose tissue mitochondrial function. Mol Nutr Food Res 2017; 61. [PMID: 28691397 DOI: 10.1002/mnfr.201700261] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 01/03/2023]
Abstract
SCOPE Obesity develops when energy intake exceeds energy expenditure. Promoting brown adipose tissue (BAT) formation and function increases energy expenditure and may protect against obesity. Cyanidin-3-glucoside (C3G) is an anthocyanin compound that occurs naturally in many fruits and vegetables. In this study, we investigated the effect and mechanism of C3G on the prevention of obesity. METHODS AND RESULTS Db/db mice received C3G dissolved in drinking water for 16 wk; drinking water served as the vehicle treatment. The total body weight, energy intake, metabolic rate, and physical activity were measured. The lipid droplets, gene expression and protein expression were evaluated by histochemical staining, real-time PCR, and western blots. We found that C3G increased energy expenditure, limited weight gain, maintained glucose homeostasis, reversed hepatic steatosis, improved cold tolerance, and enhanced BAT activity in obese db/db mice. C3G also induces brown-like adipocytes (beige) formation in subcutaneous white adipose tissue (sWAT) of db/db mice model. We also found that C3G potently regulates the transcription of uncoupling protein 1 (UCP1) both in BAT and sWAT through increasing mitochondrial number and function. CONCLUSION Our results suggest that C3G plays a role in regulating systemic energy balance, which may have potential therapeutic implications for the prevention and control of obesity.
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MESH Headings
- Adipogenesis
- Adipose Tissue, Brown/enzymology
- Adipose Tissue, Brown/metabolism
- Adipose Tissue, Brown/ultrastructure
- Adipose Tissue, White/enzymology
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/pathology
- Animals
- Anthocyanins/therapeutic use
- Behavior, Animal
- Dietary Supplements
- Energy Intake
- Energy Metabolism
- Gene Expression Regulation
- Glucosides/therapeutic use
- Liver/enzymology
- Liver/metabolism
- Liver/pathology
- Locomotion
- Male
- Mice, Mutant Strains
- Microscopy, Electron, Transmission
- Mitochondria/enzymology
- Mitochondria/metabolism
- Mitochondria/ultrastructure
- Non-alcoholic Fatty Liver Disease/metabolism
- Non-alcoholic Fatty Liver Disease/pathology
- Non-alcoholic Fatty Liver Disease/prevention & control
- Obesity/metabolism
- Obesity/pathology
- Obesity/prevention & control
- Thermotolerance
- Uncoupling Protein 1/genetics
- Uncoupling Protein 1/metabolism
- Up-Regulation
- Whole Body Imaging
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Affiliation(s)
- Yilin You
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- College of Horticulture, China Agricultural University, Beijing, China
| | - Xiaoxue Yuan
- Institute of Infectious Diseases, Beijing Ditan Hospital, Beijing Key Laboratory of Emerging Infectious Diseases, Capital Medical University, Beijing, China
| | - Xiaomeng Liu
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- The University of the Chinese Academy of Sciences, Beijing, China
- Institute of Neuroscience and Translational Medicine, College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, China
| | - Chen Liang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- ARC Training Centre for Innovative Wine Production, The University of Adelaide, SA, Australia
| | - Minghui Meng
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Yuanyuan Huang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- The University of the Chinese Academy of Sciences, Beijing, China
| | - Xue Han
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Jielong Guo
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yu Guo
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Chenglong Ren
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Qianwen Zhang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiangyu Sun
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Tingting Ma
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- College of Food Engineering and Nutritional Science, Shanxi Normal University, Xi'an, China
| | - Guojie Liu
- College of Horticulture, China Agricultural University, Beijing, China
| | - Wanzhu Jin
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- The University of the Chinese Academy of Sciences, Beijing, China
| | - Weidong Huang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Jicheng Zhan
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
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Abstract
The introduction of sibutramine has brought a new therapeutic option for the management of many overweight and obese patients. To date it has been used by more than eight million patients in over 70 countries. As part of a comprehensive programme that includes diet and lifestyle guidance, the additive effect of sibutramine (10 or 15 mg/day) facilitates patients to achieve and sustain greater weight loss. Overall weight loss is typically 5—10% of starting body weight, and this is almost entirely due to loss of excess adipose tissue. Commensurate with this level of weight loss, benefits have been noted in comorbidities such as insulin resistance, type 2 diabetes and dyslipidaemia. Sibutramine is a serotonin-noradrenaline (norepinephrine) re-uptake inhibitor which acts centrally to induce satiety and maintain thermogenic expenditure. The main side effects are increased heart rate and blood pressure which are generally small, but require frequent checks.
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Affiliation(s)
- Caroline Day
- Diabetes Group, Pharmaceutical Sciences, Aston University, Birmingham, B4 7ET, UK,
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Abstract
There is an urgent need for effective pharmacological therapies to help tackle the growing obesity epidemic and the healthcare crisis it poses. The past 3 years have seen approval of a number of novel anti-obesity drugs. The majority of these influence hypothalamic appetite pathways via dopaminergic or serotoninergic signalling. Some are combination therapies, allowing lower doses to minimize the potential for off-target effects. An alternative approach is to mimic endogenous satiety signals using long-lasting forms of peripheral appetite-suppressing hormones. There is also considerable interest in targeting thermogenesis by brown adipose tissue to increase resting energy expenditure. Obesity pharmacotherapy has seen several false dawns, but improved understanding of the pathways regulating energy balance, and better-designed trials, give many greater confidence that recently approved agents will be both efficacious and safe. Nevertheless, a number of issues from preclinical and clinical development continue to attract debate, and additional large-scale trials are still required to address areas of uncertainty.
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Abstract
Foods and dietary patterns that enhance satiety may provide benefit to consumers. The aim of the present review was to describe, consider and evaluate research on potential benefits of enhanced satiety. The proposal that enhanced satiety could only benefit consumers by a direct effect on food intake should be rejected. Instead, it is proposed that there is a variety of routes through which enhanced satiety could (indirectly) benefit dietary control or weight-management goals. The review highlights specific potential benefits of satiety, including: providing appetite control strategies for consumers generally and for those who are highly responsive to food cues; offering pleasure and satisfaction associated with low-energy/healthier versions of foods without feeling 'deprived'; reducing dysphoric mood associated with hunger especially during energy restriction; and improved compliance with healthy eating or weight-management efforts. There is convincing evidence of short-term satiety benefits, but only probable evidence for longer-term benefits to hunger management, possible evidence of benefits to mood and cognition, inadequate evidence that satiety enhancement can promote weight loss, and no evidence on which consumers would benefit most from satiety enhancement. The appetite-reducing effects of specific foods or diets will be much more subtle than those of pharmaceutical compounds in managing hunger; nevertheless, the experience of pharmacology in producing weight loss via effects on appetite suggests that there is potential benefit of satiety enhancement from foods incorporated into the diet to the consumer.
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Dietrich MO, Horvath TL. Limitations in anti-obesity drug development: the critical role of hunger-promoting neurons. Nat Rev Drug Discov 2012; 11:675-91. [DOI: 10.1038/nrd3739] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Halford JCG, Boyland EJ, Lawton CL, Blundell JE, Harrold JA. Serotonergic anti-obesity agents: past experience and future prospects. Drugs 2012; 71:2247-55. [PMID: 22085383 DOI: 10.2165/11596680-000000000-00000] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The role of serotonin (5-hydroxytryptamine) in appetite control is long established. Serotonergic manipulations reduce food intake in rodents in a manner consistent with satiety. In humans, drugs such as fenfluramine, dexfenfluramine and sibutramine all reduce energy intake, suppress hunger and enhance satiety. Effects on eating behaviour and subjective sensations of appetite are associated with the weight loss-inducing effects of these treatments. Currently, no appetite-suppressing drugs are approved specifically for the treatment of obesity. However, a new generation of serotonergic drugs have progressed through clinical development. The serotonin 5-HT(2C)-receptor selective agonist lorcaserin, a drug specifically developed to target satiety without producing the side effect profiles of its predecessors, has been shown to significantly reduce energy intake and body weight. The weight loss produced by lorcaserin appears modest, and behavioural effects, particularly its supposed satiety-enhancing effects, have yet to be characterized. The monoaminergic re-uptake inhibitor tesofensine has also been shown to produce impressive weight loss in smaller-scale clinical studies. It remains unclear if this drug produces any effects on appetite mediated by serotonin, or whether weight loss is produced largely through enhanced energy expenditure. Evidence indicates that tesofensine strengthens satiety, but behavioural specificity and psychological side effects remain an issue. The serotonergic system remains a viable target for anti-obesity treatment. In this review, we examine the limited behavioural data available on these two new CNS-acting appetite suppressants.
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Sibutramine promotes amygdala activity under fasting conditions in obese women. Psychopharmacology (Berl) 2012; 221:693-700. [PMID: 22193727 DOI: 10.1007/s00213-011-2615-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
RATIONALE Sibutramine, a centrally-acting selective monoamine reuptake inhibitor, has been used as an appetite suppressant drug in obesity. OBJECTIVES To gain insight into the central nervous actions of sibutramine, brain responses to pictures of food items after sibutramine vs placebo application were assessed by functional magnetic resonance imaging (fMRI) in obese women. METHODS In a randomized double-blind crossover design, 10 healthy obese women (BMI 31.8-39.9 kg/m(2)) received 15 mg/d of sibutramine vs placebo for 14 d. Obese participants, and a group of 10 age-matched normal weight controls, viewed pictures of food items and control objects in hungry and satiated states while lying in the MR scanner. The paradigm followed a block design. In obese participants, fMRI measurements were conducted prior and after two weeks of daily sibutramine or placebo administration, whereas control participants were scanned only at one point in time. RESULTS Upon food item presentation, obese participants showed increased brain activity in areas related to emotional and reward processing, perceptual processing, and cognitive control as compared to normal weight controls. Sibutramine exerted a divergent satiety-dependent effect on amygdala activity in obese participants, increasing activity in the hungry state while decreasing it under conditions of satiation. CONCLUSIONS Our results demonstrate a modulatory influence of sibutramine on amygdala activity in obese women which may underlie the appetite suppressant effects of the drug.
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The emulsified lipid Fabuless (Olibra) does not decrease food intake but suppresses appetite when consumed with yoghurt but not alone or with solid foods: A food effect study. Physiol Behav 2012; 105:742-8. [DOI: 10.1016/j.physbeh.2011.08.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 11/19/2022]
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Abstract
The role of serotonin (5-HT) in appetite control is well recognised. 5-HT drugs reduce food intake in rodents in a manner consistent with an enhancement of satiety. In humans, they have been shown to reduce caloric intake, an effect associated with reduced hunger and increased satiety. These effects appear to be mediated, at least in part, by the 5-HT(2C) receptor subtype. 5-HT-acting drugs such as fenfluramine, d-fenfluramine, and sibutramine have provided effective anti-obesity treatments in the past. However, more selective agents are needed that produce the same changes in eating behaviour and induce weight loss without unacceptable side effects. Lorcaserin, a selective 5-HT(2C) receptor agonist, is a novel anti-obesity agent that reduces both energy intake and body weight. The effects of lorcaserin on eating behaviour remain to be characterised as does its behavioural specificity.
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Affiliation(s)
- Jason C G Halford
- Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, UK.
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16
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Abstract
Obesity is a major health problem worldwide. It is associated with cardiovascular diseases, diabetes mellitus and decreased longevity. In managing obesity, diet and exercise are essential; pharmacological therapy may be added for obese patients or overweight patients with cardiovascular risk factors. Sibutramine is a serotonergic and adrenergic drug that reduces food intake and increases thermogenesis. It reduces bodyweight by about 4.2 kg after 12 months, and improves blood glucose and lipids; however, it can increase heart rate and blood pressure. In the SCOUT (Sibutramine Cardiovascular OUTcomes) study, sibutramine increased serious cardiovascular events, such as stroke or myocardial infarction, compared with placebo, and was consequently withdrawn from the market. The lesson learnt from this is the importance of patient selection, limiting the duration of treatment and stopping treatment in non-responders. Currently, phentermine and amfepramone (diethylpropion) are approved for short-term treatment of obesity (up to 3 months) and orlistat is approved for longer-term treatment; however, the gastrointestinal adverse effects of orlistat may be intolerable for some patients. There is now a clear need to find anti-obesity drugs that are effective and safe in the long term.
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Abstract
Obesity is a worldwide epidemic and there is an urgent need for the development of effective pharmacological therapies that target the metabolic and behavioral factors of body weight regulation. Serotonin (5-HT) has been implicated as a critical factor in the short-term (meal-by-meal) regulation of food intake and pharmaceutical companies have invested millions of dollars to discover and develop drug targets for the serotonergic pathway. Lorcaserin is a novel selective agonist of the 5-HT(2C) receptor for weight loss therapy. Preclinical and clinical studies indicate lorcaserin is well tolerated and not associated with cardiac valvulopathy or pulmonary hypertension suggesting that lorcaserin is a selective 5-HT(2C) receptor agonist and has little or no activation of the 5-HT(2B) and 5-HT(2A) receptors, respectively. Lorcaserin acts to alter energy balance through a reduction in energy intake and without an increase in energy expenditure and achieved the U.S. Food and Drug Administration guidelines for weight loss efficacy. It remains to be determined whether or not lorcaserin will be approved for the long-term management of obesity.
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Affiliation(s)
- L M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA.
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18
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No efficacy of processed Fabuless (Olibra) in suppressing appetite or food intake. Eur J Clin Nutr 2010; 65:81-6. [DOI: 10.1038/ejcn.2010.187] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fountaine RJ, Taylor AE, Mancuso JP, Greenway FL, Byerley LO, Smith SR, Most MM, Fryburg DA. Increased food intake and energy expenditure following administration of olanzapine to healthy men. Obesity (Silver Spring) 2010; 18:1646-51. [PMID: 20134408 DOI: 10.1038/oby.2010.6] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atypical antipsychotic medications like olanzapine (OLZ) induce weight gain and increase the risk of diabetes in patients with schizophrenia. The goal of this study was to assess potential mechanisms of OLZ-induced weight gain and accompanying metabolic effects. Healthy, lean, male volunteers received OLZ and placebo (PBO) in a randomized, double-blind, crossover study. In periods 1 and 2, subjects received OLZ (5 mg for 3 days then OLZ 10 mg for 12 days) or matching PBO separated by a minimum 12-day washout. Twenty-four hour food intake (FI), resting energy expenditure (REE), activity level, metabolic markers, and insulin sensitivity (IS) were assessed. In total, 30 subjects were enrolled and 21 completed both periods. Mean age and BMI were 27 years (range: 18-49 years) and 22.6 +/- 2.2 kg/m(2), respectively. Relative to PBO, OLZ resulted in a 2.62 vs. 0.08 kg increase in body weight (P < 0.001) and 18% (P = 0.052 or 345 kcal) increase in FI. Excluding one subject with nausea and dizziness on the day of OLZ FI measurement, the increase in FI was 547 kcal, (P < 0.05). OLZ increased REE relative to PBO (113 kcal/day, P = 0.003). Significant increases in triglycerides, plasminogen activator inhibitor-I (PAI-I), leptin, and tumor necrosis factor-alpha (TNF-alpha) were observed. No significant differences in activity level or IS were observed. This study provides evidence that OLZ pharmacology drives the early increase in weight through increased FI, without evidence of decreased energy expenditure (EE), activity level, or short-term perturbations in IS.
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Halford JCG, Boyland EJ, Blundell JE, Kirkham TC, Harrold JA. Pharmacological management of appetite expression in obesity. Nat Rev Endocrinol 2010; 6:255-69. [PMID: 20234354 DOI: 10.1038/nrendo.2010.19] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For obese individuals, successful weight loss and maintenance are notoriously difficult. Traditional drug development fails to exploit knowledge of the psychological factors that crucially influence appetite, concentrating instead on restrictive criteria of intake and weight reduction, allied to a mechanistic view of energy regulation. Drugs are under development that may produce beneficial changes in appetite expression in the obese. These currently include glucagon-like peptide-1 analogs such as liraglutide, an amylin analog davalintide, the 5-HT(2C) receptor agonist lorcaserin, the monoamine re-uptake inhibitor tesofensine, and a number of combination therapies such as pramlintide and metreleptin, bupropion and naltrexone, phentermine and topiramate, and bupropion and zonisamide. However, the effects of these treatments on eating behavior remain poorly characterized. Obesity is typically a consequence of overconsumption driven by an individual's natural sensitivity to food stimuli and the pleasure derived from eating. Intuitively, these processes should be effective targets for pharmacotherapy, and behavioral analysis can identify drugs that selectively affect desire to eat, enjoyment of eating, satiation or postmeal satiety. Rational interventions designed specifically to modulate these processes could limit the normally aversive consequences of caloric restriction and maximize an individual's capacity to successfully gain control over their appetite.
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Affiliation(s)
- Jason C G Halford
- School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.
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Abstract
Functional food products promote claims such as 'freedom from hunger' and 'feel fuller for longer'. A legislative framework has been established by the European Food Safety Authority to evaluate the validity of such claims: a claim must be substantiated by scientific evidence and should be clearly understood by consumers. Since consumed foods influence appetite by means of a system of physiological satiety signals, functional foods could in principle act by increasing the potency and/or duration of these signals. Importantly, what constitutes a useful action: a reduction in hunger, an increase in fullness, a change in food intake at a meal, an adjustment in daily energy balance or a reduction in body weight? Any claim should not go beyond the scientific evidence of an effect, and methods exist to scientifically evaluate claims. The wording of a claim is, therefore, critical. The difference between a proof of concept and a guarantee of success is an important point that needs to be conveyed to the consumer.
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Affiliation(s)
- John Blundell
- Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
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Halford JCG, Boyland EJ, Cooper SJ, Dovey TM, Huda MSB, Dourish CT, Dawson GR, Wilding JPH. The effects of sibutramine on the microstructure of eating behaviour and energy expenditure in obese women. J Psychopharmacol 2010; 24:99-109. [PMID: 18755818 DOI: 10.1177/0269881108095195] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the suggestion that many potential anti-obesity drugs may enhance within-meal satiation, few studies have directly measured the effects of any drug on the microstructure of human eating behaviour. The effects of 7 days dosing with sibutramine 10 mg and 15 mg a day on appetite and energy balance were determined in 30 obese women (BMI 34.6 +/- 3.3 kg/m2, age 46.0 +/- 12.9 years) using a Universal Eating Monitor (UEM) and indirect calorimetry, in a double-blind, placebo-controlled crossover study. At day 7, sibutramine 10 mg and 15 mg reduced food intake by 16.6% and 22.3%, respectively (p < 0.001), compared with placebo. Sibutramine reduced eating rate compared with placebo rather than meal length (10 mg p < 0.05; 15 mg p < 0.001). In addition, sibutramine 10 mg significantly reduced hunger later in the meal (p < 0.05) and sibutramine 15 mg increased fullness early in the meal (p < 0.01), both of which are consistent with enhanced within-meal satiation. Sibutramine had little effect on resting metabolic rate, although 15 mg did significantly reduce respiratory quotient at several time points during the test day. These results provide novel evidence that decreased consumption of a test meal induced by sibutramine is primarily because of reduced eating rate, enhancing the deceleration in cumulative food intake within a meal associated with the development of satiety. Changes in within-meal appetite ratings appear particularly sensitive to drug-induced enhancement of satiation, and may provide key indices for assessing the therapeutic potential of novel anti-obesity drugs.
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Affiliation(s)
- J C G Halford
- Kissileff Laboratory, School of Psychology, University of Liverpool, Liverpool, UK.
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Potent and selective agonism of the melanocortin receptor 4 with MK-0493 does not induce weight loss in obese human subjects: energy intake predicts lack of weight loss efficacy. Clin Pharmacol Ther 2009; 86:659-66. [PMID: 19741604 DOI: 10.1038/clpt.2009.167] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MK-0493 is a novel, potent, and selective agonist of the melanocortin receptor 4 (MC4R), one of the best-validated genetic targets and considered one of the most promising for the development of antiobesity therapeutics. An ad libitum energy-intake model was qualified with excellent reproducibility: the geometric mean ratio (GMR) with 95% confidence interval (CI) for total energy intake over a period of 24 h for 30 mg sibutramine/placebo was 0.82 (0.76, 0.88), and for 10 mg sibutramine/placebo it was 0.98 (0.91, 1.05). MK-0493 showed a small and marginally significant effect on 24-h energy intake, whereas 30 mg of sibutramine caused a significant reduction in total 24-h energy intake; specifically, the GMR (95% CI) for 30 mg sibutramine/placebo was 0.79 (0.74, 0.85). MK-0493 was associated with modest weight reduction from baseline but had only small, statistically insignificant effects relative to placebo after 12 weeks in a fixed-dose study and also after 18 weeks of stepped-titration dosing. We conclude that agonism of MC4R is not likely to represent a viable approach to the development of antiobesity therapeutics.
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Martin CK, Han H, Anton SD, Greenway FL, Smith SR. Effect of valproic acid on body weight, food intake, physical activity and hormones: results of a randomized controlled trial. J Psychopharmacol 2009; 23:814-25. [PMID: 18583434 PMCID: PMC2753432 DOI: 10.1177/0269881108091595] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to identify mechanisms through which valproic acid (VPA) causes weight gain. Healthy participants (N = 52) were randomized to VPA or placebo in a double-blind study. Energy intake (EI) was measured in the laboratory at lunch and dinner, and physical activity (PA) was measured with accelerometry. Glucose levels and hormones [Peptide YY(3-36), glucagon-like peptide-1 (GLP-1), leptin, ghrelin, insulin] that regulate EI were measured. Assessments occurred at baseline and week 3. Change from baseline was evaluated with mixed models (alpha = 0.05). Weight significantly increased in the VPA group (+0.49 kg), but not the placebo group. The VPA group increased fast food fats cravings and decreased glucose levels compared with placebo. Change in weight, EI and PA did not differ by group. Within group analyses indicated that the VPA group increased PA, hunger, binge eating, depression and GLP-1. VPA-associated weight gain is not likely due to changes in PA or the gut hormones studied. Although EI did not increase when measured after 3 weeks of treatment, VPA decreased glucose levels and increased motivation to eat; hence, EI might have increased in the short-term. Research testing VPA on short-term (1 week) EI, metabolism, and substrate partitioning is warranted.
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Affiliation(s)
- CK Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - H Han
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - SD Anton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - FL Greenway
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - SR Smith
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Tziomalos K, Krassas GE, Tzotzas T. The use of sibutramine in the management of obesity and related disorders: an update. Vasc Health Risk Manag 2009; 5:441-52. [PMID: 19475780 PMCID: PMC2686261 DOI: 10.2147/vhrm.s4027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aims: To review the major trials that evaluated the efficacy and safety of the use of sibutramine for weight loss and the impact of this agent on obesity-related disorders. Methods and results: The most important articles on sibutramine up to January 2009 were located by a PubMed and Medline search. Sibutramine reduces food intake and body weight more than placebo and has positive effects on the lipid profile (mainly triglycerides and high density lipoprotein cholesterol), glycemic control and inflammatory markers in studies for up to one year. Preliminary studies showed that sibutramine may also improve other obesity-associated disorders such as polycystic ovary syndrome, left ventricular hypertrophy, binge eating disorder and adolescent obesity. The high discontinuation rates and some safety issues mainly due to the increase in blood pressure and pulse rate have to be considered. Additionally, it has not yet been established that treatment with sibutramine will reduce cardiovascular events and total mortality. Conclusions: Sibutramine, in conjunction with lifestyle measures, is a useful drug for reducing body weight and improving associated cardiometabolic risk factors and obesity-related disorders. Studies of longer duration are required to determine the precise indications of the drug, to evaluate safety issues and to assess its efficacy on cardiovascular mortality.
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Affiliation(s)
- Konstantinos Tziomalos
- Department of endocrinology, Diabetes and Metabolism, Panagia General Hospital, Thessaloniki, Greece
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Morillo JM, Bullon P, Ramirez-Tortosa MDC, Quiles JL, Newman HN, Bertoli E, Battino M. Nutrition-linked chronic disease and periodontitis: are they the two faces of the same coin? MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2009. [DOI: 10.1007/s12349-009-0055-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sharma B, Henderson DC. Sibutramine: current status as an anti-obesity drug and its future perspectives. Expert Opin Pharmacother 2008; 9:2161-73. [DOI: 10.1517/14656566.9.12.2161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Esposito P, Rampino T, Gregorini M, Soccio G, Piotti G, Bedino G, Balenzano CT, Roscini E, Cosmai L, Portalupi V, Libetta C, Dal Canton A. Severe symptomatic hyponatremia during sibutramine therapy: a case report. Am J Kidney Dis 2008; 52:137-9. [PMID: 18487000 DOI: 10.1053/j.ajkd.2008.02.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 02/25/2008] [Indexed: 02/07/2023]
Abstract
Sibutramine, a serotonin reuptake inhibitor, currently is used in treatment of obesity. The known side effects of sibutramine, ie, hypertension and tachycardia, depend on its adrenergic and serotoninergic effects. We describe a case of life-threatening hyponatremia associated with sibutramine use in an obese woman. We hypothesize that sibutramine, through its effect on neurotransmitters, may induce antidiuretic hormone secretion and lead to a syndrome of inappropriate antidiuretic hormone secretion. We advise careful monitoring of water-electrolytic balance during sibutramine therapy.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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29
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Effects of l-phenylalanine on energy intake in overweight and obese women: Interactions with dietary restraint status. Appetite 2008; 51:111-9. [DOI: 10.1016/j.appet.2008.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 12/21/2007] [Accepted: 01/10/2008] [Indexed: 11/22/2022]
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30
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Harper ME, Green K, Brand MD. The efficiency of cellular energy transduction and its implications for obesity. Annu Rev Nutr 2008; 28:13-33. [PMID: 18407744 DOI: 10.1146/annurev.nutr.28.061807.155357] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We assess the existence, mechanism, and functions of less-than-maximal coupling efficiency of mitochondrial oxidative phosphorylation and its potential as a target for future antiobesity interventions. Coupling efficiency is the proportion of oxygen consumption used to make adenosine triphosphate (ATP) and do useful work. High coupling efficiency may lead to fat deposition; low coupling efficiency to a decrease in fat stores. We review obligatory and facultative energy expenditure and the role of a futile cycle of proton pumping and proton leak across the mitochondrial inner membrane in dissipating energy. Basal proton conductance is catalyzed primarily by the adenine nucleotide translocase but can be mimicked by chemical uncouplers. Inducible proton conductance is catalyzed by specific uncoupling proteins. We discuss the opportunities and pitfalls of targeting these processes as a treatment for obesity by decreasing coupling efficiency and increasing energy expenditure, either directly or through central mechanisms of energy homeostasis.
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Affiliation(s)
- Mary-Ellen Harper
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ontario, Canada K1H 8M5.
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31
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Rotstein A, Inbar O, Vaisman N. The Effect of Sibutramine Intake on Resting and Exercise Physiological Responses. ANNALS OF NUTRITION AND METABOLISM 2008; 52:17-23. [DOI: 10.1159/000114290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 06/25/2007] [Indexed: 11/19/2022]
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Pelkman CL, Navia JL, Miller AE, Pohle RJ. Novel calcium-gelled, alginate-pectin beverage reduced energy intake in nondieting overweight and obese women: interactions with dietary restraint status. Am J Clin Nutr 2007; 86:1595-602. [PMID: 18065575 DOI: 10.1093/ajcn/86.5.1595] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Foods containing strong-gelling fibers may provide a safe and efficacious strategy for reducing food intake by stimulating endogenous satiety signaling. OBJECTIVE A novel, 2-part beverage, consisting of alginate-pectin and calcium components, that forms a stable, fibrous gel in the stomach was tested to determine its effects on subjective satiety and food intake in overweight and obese women. DESIGN The investigation was a within-subjects, double-blind, placebo-controlled study. Subjects (n = 29) ingested a 2-part beverage twice per day (once before breakfast and once midafternoon) for 7 d. Three alginate-pectin formulations were tested: 1.0 g, 2.8 g, and control (no fiber). Subjective satiety and ad libitum food intake were measured on days 1 and 7 of each 1-wk treatment period with a 1-wk washout between testings. RESULTS A significant reduction in food intake was observed at dinner for both formulations compared with the control formulation. The effects of the gel beverage differed as a function of rigid dietary restraint status. Women in the lower 50th percentile of rigid restraint consumed 12% less energy during the day and 22% less for the evening snack in the 2.8-g condition compared with the control condition. No effect was found for women in the upper 50th percentile of rigid restraint. CONCLUSIONS Consumption of a postingestion, calcium-gelled fiber beverage twice daily reduced energy intake in overweight and obese women with low rigid restraint scores. Use of foods designed to enhance satiety may be an effective adjunctive therapy for weight loss; however, more research is needed to determine how dietary restraint alters this response.
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Affiliation(s)
- Christine L Pelkman
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214-8028, USA.
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34
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Affiliation(s)
- George A Bray
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA.
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35
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Budd GM, Hayman LL, Crump E, Pollydore C, Hawley KD, Cronquist JL, Berkowitz RI. Weight loss in obese African American and Caucasian adolescents: secondary analysis of a randomized clinical trial of behavioral therapy plus sibutramine. J Cardiovasc Nurs 2007; 22:288-96. [PMID: 17589281 DOI: 10.1097/01.jcn.0000278959.75253.1d] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity, a major risk factor for cardiovascular disease, is more prevalent in African American adolescents than in their Caucasian counterparts. Effective weight loss treatment options are required to aid in the reduction of this health disparity. The purpose of this study, a secondary analysis of data collected as part of a double-blind, randomized clinical trial of behavioral and pharmacologic weight loss, was to examine and compare changes in weight loss and cardiometabolic risk factors in African American and Caucasian adolescents. METHODS Analysis included 34 African American and 45 Caucasian obese boys and postmenarcheal girls. The participants were randomized to family-based behavioral therapy plus placebo or family-based behavioral therapy plus sibutramine. Changes in weight, body mass index, % body mass index, fasting glucose, insulin, homeostatically assessed insulin resistance, and lipid levels were measured at baseline and month 6. RESULTS Mean age was 14.1 years (range 13-17 years). Average body mass index was 37.8 kg/m (32-44). Retention was 88.2% for African American adolescents and 91% for Caucasian adolescents. At baseline, African American adolescents had lower waist circumferences, triglycerides, serum glucose, and higher high-density lipoprotein cholesterol levels. At month 6, percent change in body mass index and weight loss was significantly greater in the Caucasian drug group than in placebo, whereas the weight loss for African Americans in the drug group versus those in the placebo group was not significant but had a medium effect size (Cohen d = 0.64). Irrespective of treatment group, those losing >5% of initial BMI had significant reductions in waist circumference. Caucasians had significant reductions in triglycerides, high-density lipoprotein cholesterol, glucose, insulin, and homeostatically assessed insulin resistance levels; African American responders had significant reductions in triglycerides, insulin, and homeostatically assessed insulin resistance. CONCLUSION Sibutramine impacted reductions in weight loss in both African American and Caucasian teens. Weight loss, whether by behavioral therapy alone or in combination with pharmacotherapy, produced beneficial changes in cardiometabolic risk factors in adolescents from both racial groups. Limitations included a small sample size. Longer-term obesity intervention studies addressing retention, acceptability, safety, and treatment effect on cardiometabolic risk are critical to reducing health disparities.
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Affiliation(s)
- Geraldine M Budd
- Doctoral Program, College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19102, USA.
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Affiliation(s)
- Christine Seel Ritchie
- Division of Gerontology, Geriatrics and Palliative Care, Atlanta/Birmingham VA Geriatric Research Education and Clinical Center, Department of Medicine, University of Alabama at Birmingham, USA
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Abstract
Three medications with approval for long-term use in the treatment of obesity are currently available in the United States. Sibutramine (U.S. Food and Drug Administration [FDA] approved in 1997), orlistat (FDA approved in 1999), and rimonabant (available in Europe and given FDA approvable status in 2006 and expected to be marketed in 2007) represent modern approaches to medications used adjunctively for weight management. As demonstrated in large clinical trials of 2 to 4 years' duration, these medications significantly increase weight loss compared with placebo; weight loss with these drugs reaches a nadir between 20 and 28 weeks; weight loss, averaged 8%-10%, with the placebo contributing 4%-6% of that. Weight maintenance is demonstrated as long as adherence to medication continues. All medications have side effects that need to be considered. For sibutramine, there is a rise in blood pressure and heart rate that may require discontinuation of the drug in a small percent of patients. For orlistat, steatorrhea produces the principal gastrointestinal side effects. Rimonabant appears to have a favorable safety and tolerability profile. Nausea and gastrointestinal symptoms are the chief tolerability issue, but they are usually self-limited. In addition there are several drugs and drug combinations in phase 2 or phase 2 trials that will be reported on in the coming years.
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Affiliation(s)
- George A Bray
- Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA.
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Peck RW. Driving earlier clinical attrition: if you want to find the needle, burn down the haystack. Considerations for biomarker development. Drug Discov Today 2007; 12:289-94. [PMID: 17395088 DOI: 10.1016/j.drudis.2007.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/22/2007] [Accepted: 02/05/2007] [Indexed: 11/22/2022]
Abstract
Drug development attrition rates are rising and late phase attrition remains high, contributing to an unsustainable increase in R&D spending. Consequently, there is much effort to identify the potentially successful molecules earlier in development with the use of biomarkers to predict potential efficacy and safety. However, focussing only on picking the winners earlier will not solve the problem. It is essential that the evaluation of these biomarkers also enables the earlier termination of the molecules that will not have the required activity.
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Affiliation(s)
- Richard W Peck
- Lilly Research Centre, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK.
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Van Mil EGAH, Westerterp KR, Kester ADM, Delemarre-van de Waal HA, Gerver WJM, Saris WHM. The effect of sibutramine on energy expenditure and body composition in obese adolescents. J Clin Endocrinol Metab 2007; 92:1409-14. [PMID: 17264187 DOI: 10.1210/jc.2006-0264] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Childhood obesity is now considered to be an epidemic. Drug therapy in this age group remains a topic of research. OBJECTIVE The objective of this study was to examine the effect of treatment with sibutramine (10 mg) on body composition and energy expenditure in obese adolescents. DESIGN The study was conducted as a randomized, double-blind, placebo-controlled trial. SETTING The study was set in an obesity research center. PATIENTS The patients were 24 obese adolescents (age 12-17 yr, 11 boys); four patients withdrew. INTERVENTION Intervention was sibutramine (Meridia) or placebo in combination with an energy-restricted diet and exercise plan for 12 wk, followed by an identical, but medication-free, treatment period (follow-up). MAIN OUTCOME MEASURE Change in body mass index (BMI) sd score (BMI-SDS) was the principal measure of efficacy. Body composition and total energy expenditure were measured by stable isotopes and further calculated according to the four-component model, using underwater weighing and dual x-ray absorptiometry. Basal metabolic rate (BMR) was measured by ventilated hood and adjusted for sex and body composition (BMRadj). RESULTS After intervention, the decrease in BMI-SDS was comparable in both groups. During follow-up, BMI further decreased in the placebo group but stabilized in the sibutramine group. Changes in the percentage of fat mass were not different between both groups. BMRadj decreased in the placebo group and remained constant in the sibutramine group. During follow-up, BMRadj decreased in the sibutramine group and increased in the placebo group. Changes in total energy expenditure were not significantly different. CONCLUSION The effect of sibutramine on BMI-SDS was not significant. Sibutramine may diminish the decrease in BMRadj associated with energy restriction in obese adolescents.
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Affiliation(s)
- Edgar G A H Van Mil
- Department of Methodology and Statistics and Human Biology, Nutrition Environment and Toxicology Research Institute Maastrict, Maastrict University, and Department of Pediatrics, University Hospital Maastrict, The Netherlands.
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Halford JCG, Harrold JA, Boyland EJ, Lawton CL, Blundell JE. Serotonergic drugs : effects on appetite expression and use for the treatment of obesity. Drugs 2007; 67:27-55. [PMID: 17209663 DOI: 10.2165/00003495-200767010-00004] [Citation(s) in RCA: 242] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Over 35 years of research suggests that endogenous hypothalamic serotonin (5-hydroxytryptamine) plays an important part in within-meal satiation and post-meal satiety processes. Thus, the serotonin system has provided a viable target for weight control, critical to the action of at least two effective anti-obesity treatments, both producing clinically significant weight loss over a year or more. Numerous serotonin receptor subtypes have been identified; of these, serotonin 5-HT1B and 5-HT2C receptors have been specifically recognised as mediators of serotonin-induced satiety.A number of serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs), dexfenfluramine and 5-HT2C receptor agonists, have been shown to significantly attenuate rodent bodyweight gain. This effect is strongly associated with marked hypophagia and is probably mediated by the hypothalamic melanocortin system. Additionally, sibutramine, dexfenfluramine, fluoxetine and the 5-HT2C receptor agonist chlorophenylpiperazine (mCPP) have all been shown to modify appetite in both lean and obese humans, resulting in reduced caloric intake. Clinical studies demonstrate serotonergic drugs specifically reduce appetite prior to and following the consumption of fixed caloric loads, and cause a reduction in pre-meal appetite and caloric intake at ad libitum meals. Weight loss in the obese has also been produced by treatment with both the serotonin precursor 5-hydroxytryptophan and the preferential 5-HT2C receptor agonist mCPP.A new generation of 5-HT2C receptor selective agonists have been developed and at least one, lorcaserin (APD356), is currently undergoing clinical trials. In addition, 5-HT6 receptor antagonists such as PRX-07034 and BVT74316 have been shown to potently reduce food intake and bodyweight gain in rodent models and have recently entered clinical trials. However, the role of the 5-HT6 receptor in the expression of appetite remains to be determined. The hope is that these drugs will not only be free of their predecessors' adverse effect profiles, but will also be equally or more effective at regulating appetite and controlling bodyweight.
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Affiliation(s)
- Jason C G Halford
- Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Liverpool, UK.
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41
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The Metabolic Syndrome. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Chaput JP, Tremblay A. Current and novel approaches to the drug therapy of obesity. Eur J Clin Pharmacol 2006; 62:793-803. [PMID: 16937118 DOI: 10.1007/s00228-006-0186-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 07/11/2006] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Obesity has been described as the greatest current threat to human health. Although diet and lifestyle changes remain the cornerstones of therapy for obesity, weight losses are often small, and long-term success is disappointing. DISCUSSION When these lifestyle-modifying attempts fail, the use of anti-obesity drugs is warranted. Drug treatment is often indicated, but is somewhat limited by the minimal number of well-tolerated drugs that have proven to have long-term efficacy in maintaining body weight loss. The currently available drugs, sibutramine and orlistat, appear modestly effective in promoting weight loss. However, pharmacological therapy for obesity is in transition; expanding knowledge of the physiological mechanisms of body weight regulation has revealed new molecular targets, and more than 150 novel agents are under active development. CONCLUSIONS Because weight regulation is complex, and redundant systems protect against perceived starvation, optimal treatment of obesity will likely require combinations of therapies. In addition, a better comprehension of the problem prior to its treatment would be preferable before targeting homeostatic pathways which could be irrelevant.
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Affiliation(s)
- Jean-Philippe Chaput
- Division of Kinesiology, Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Ste-Foy, Québec, G1K 7P4, Canada
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Tremblay A, Therrien F. Physical activity and body functionality: implications for obesity prevention and treatment. Can J Physiol Pharmacol 2006; 84:149-56. [PMID: 16900940 DOI: 10.1139/y05-132] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity promotes metabolic adaptations that improve body functionality and contribute to the prevention of some diseases. With respect to energy and fat balance, physical activity facilitates the equilibrium between energy intake and expenditure as well as between fat intake and fat oxidation. When combined with a healthy diet that favors satiety with a reduced energy intake, exercise can induce a substantial mass loss in obese individuals. However, even the impact of an exemplary lifestyle does not seem to have the potential to decrease body mass in obese individuals down to the mass range of lean people. Up to now, we have not been able to induce mass changes exceeding 12%–15% initial body mass in obese male subjects under tolerable exercise and dietary habits, and this moderate success was accompanied by modifications in appetite and energy expenditure susceptible to compromise subsequent mass stability. As described in this paper, many environmental factors can influence energy balance and the ability to lose body fat in response to a healthy diet and (or) physical activity program. Particular attention is given to preliminary data obtained in our laboratory that suggest that knowledge-based work does not favor the same potential mass reducing effects as physical work. In fact, the acute effects of knowledge-based work suggest that this work modality may be rather susceptible to promote a more pronounced positive energy balance compared with what we may expect from a sedentary relaxing activity. This is problematic for obesity prevention in the future since knowledge-based work now represents the main working modality in a context of modernity.
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Affiliation(s)
- Angelo Tremblay
- Division of Kinesiology, PEPS, Laval University, QC G1K 7P4, Canada.
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Jain DS, Subbaiah G, Sanyal M, Shrivastav PS, Pal U, Ghataliya S, Kakad A, Patel H, Shah S. Liquid chromatography/electrospray ionization tandem mass spectrometry validated method for the simultaneous quantification of sibutramine and its primary and secondary amine metabolites in human plasma and its application to a bioequivalence study. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2006; 20:3509-21. [PMID: 17072906 DOI: 10.1002/rcm.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A high-throughput and sensitive bioanalytical method using liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) has been developed for the estimation of sibutramine and its two metabolites (M1 and M2). The extraction of sibutramine, its metabolites and imipramine (internal standard (IS)) from the plasma involved treatment with phosphoric acid followed by solid-phase extraction (SPE) using a hydrophilic-lipophilic balanced HLB cartridge. The SPE eluate without drying and reconstitution was analyzed by LC/MS/MS, equipped with a with turbo ion spray (TIS) source, operating in the positive and multiple reaction monitoring (MRM) acquisition mode. Sample preparation by this method yielded extremely clean extracts with quantitative and consistent mean recoveries; 95.12% for sibutramine, 92.74% for M1, 95.97% for M2 and 96.60% for the IS. The total chromatographic run time was 3.0 min with retention times of 2.51, 2.13, 2.09 min for sibutramine, M1, M2 and imipramine, respectively. The developed method was validated in human plasma matrix, with a sensitivity of 0.1 ng/mL (coefficient of variance (CV), 2.07%) for sibutramine, 0.1 ng/mL (CV, 3.59%) for M1 and 0.2 ng/mL (CV, 4.93%) for M2. Validation of the method for its accuracy, precision, recovery, matrix effect and stability was carried out especially with regard to real subject sample analysis. The response was linear over the dynamic range 0.1 to 8.0 ng/mL for sibutramine and M1, and 0.2 to 16.0 ng/mL for M2 with correlation coefficients of r > or = 0.9959 (sibutramine), 0.9935 (M1) and 0.9943 (M2). The method was successfully applied for bioequivalence studies in 40 human subjects with 15 mg capsule formulations.
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Affiliation(s)
- Deepak S Jain
- Department of Chemistry, School of Sciences, Gujarat University, Navrangpura, Ahmedabad 380 009, India
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Halford JCG. Pharmacotherapy for obesity. Appetite 2006; 46:6-10. [PMID: 16229924 DOI: 10.1016/j.appet.2005.07.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 12/28/2004] [Accepted: 07/28/2005] [Indexed: 11/20/2022]
Abstract
The current obesity pandemic imposes a major global disease burden. However, sustained weight loss of between 5 and 10% in the obese confers marked health benefits. Currently available pharmacotherapies, orlistat and sibutramine, can induce weight loss of between 5 and 10% over 2 years or more. However, in these trials, drug induced weight loss tends to be only 2-4 kg greater than that produced by placebo control. Despite this, in the XENDOS trial, the modest placebo-subtract weight loss produced by orlistat (2.8 kg) reduced the incidence of diabetes by over a third. Recent data on the potential anti-obesity drug rimonabant are also reviewed.
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Affiliation(s)
- Jason C G Halford
- Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.
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Foltin RW. Effects of sibutramine on the appetitive and consummatory aspects of feeding in non-human primates. Physiol Behav 2005; 87:280-6. [PMID: 16352322 DOI: 10.1016/j.physbeh.2005.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 08/26/2005] [Accepted: 10/19/2005] [Indexed: 11/24/2022]
Abstract
This study examined how sibutramine (0.06-4.0 mg/kg, i.m.), a clinically effective weight-loss medication which increases extracellular serotonin and norepinephrine levels, affected the appetitive and consummatory aspects of feeding of non-human primates. The effects were compared to the effects of the positive control dexfenfluramine (2.0-6.0 mg/kg, p.o.), which primarily increases extracellular serotonin levels. Baboons had access to food 24 h each day, but they had to complete a two-phase operant procedure in order to eat. Responding on one lever during a 30-min appetitive phase was required before animals could start a consumption phase, where responding on another lever led to food delivery, i.e., a meal. Responding during the appetitive phase resulted in presentations of food-related stimuli only. Sibutramine increased the latency to the first meal of the session in females, and decreased consummatory behavior without affecting other appetitive behavior in males and females. In contrast, dexfenfluramine, increased the latency to the first meal of the session, and decreased both appetitive and consummatory behavior in males and females. The behavioral mechanism by which sibutramine decreases food intake is distinct from other anorectic drugs, including dexfenfluramine, that have been tested in this paradigm.
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Affiliation(s)
- Richard W Foltin
- Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA.
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Abstract
Sibutramine is a selective serotonin and noradrenaline re-uptake inhibitor approved for the long-term management of obesity. Its primary mechanism of action is increased satiety, although some evidence also suggests increased energy expenditure could play a role in sibutramine-induced weight loss. It has established general efficacy in long-term trials, with clinically-approved doses of 10 and 15 mg. Sibutramine has also been studied in a number of unique populations, including obese controlled hypertensives, diabetics and ethnic minorities, further establishing its effectiveness. However, it does have a consistent effect of increasing blood pressure and pulse. Thus, blood pressure and heart rate should be monitored in patients using sibutramine and it may not be applicable in obese patients with significant cardiovascular disease.
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Filippatos TD, Kiortsis DN, Liberopoulos EN, Mikhailidis DP, Elisaf MS. A review of the metabolic effects of sibutramine. Curr Med Res Opin 2005; 21:457-68. [PMID: 15811215 DOI: 10.1185/030079905x38132] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obesity is associated with an increased incidence of diabetes, hypertension, dyslipidaemia and coronary artery disease. Current management strategies of obesity include lifestyle management strategies of obesity include lifestyle interventions and pharmaco therapy. Sibutramine is a drug with established efficacy in weight reduction and maintenance of weight loss. It reduces food intake and attenuates the fall in reduces food intake and attenuates the fall in metabolic rate associated with weight loss. OBJECTIVE To review the metabolic effects associated with sibutramine use. METHODS Relevant articles were identified through a Medline search (up to December 2004). RESULTS Weight loss with sibutramine treatment is associated with improved insulin sensitivity and a fall in glycosylated haemoglobin levels in type 2 diabetic patients. In most trials sibutramine exerted favourable effects on lipids, especially exerted favourable effects on lipids, especially on high density lipoprotein (HDL) cholesterol and triglycerides, as well as on the total:HDL cholesterol ratio. Sibutramine also lowers serum uric acid concentrations. Furthermore, this drug seems to favourably influence adipocytokines; it reduces serum leptin and resistin levels and increases adiponectin levels. Sibutramine also exerts a beneficial effect on hyper androgenaemia in obese women with polycystic ovary syndrome. Preliminary findings also suggest that weight loss following treatment with sibutramine is useful in patients with non-alcoholic fatty liver disease (NAFLD). CONCLUSION Weight loss following sibutramine administration is associated with several favourable metabolic effects.
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Affiliation(s)
- T D Filippatos
- Department of Internal Medicine, Medical School, University of Ioannina, Greece
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Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 2005:CD004096. [PMID: 15674929 PMCID: PMC6718205 DOI: 10.1002/14651858.cd004096.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Obesity is closely related to type 2 diabetes and long-term weight reduction is an important part of the care delivered to obese persons with diabetes. OBJECTIVES To assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes. SEARCH STRATEGY Computerized searches were performed of MEDLINE (January 1966 to May 2004), EMBASE (January 1974 to May 2004, Web of Science (January 1981 to May 2004, and other electronic bibliographic databases, supplemented with hand searches of reference lists and selected journals. SELECTION CRITERIA Randomized, controlled trials were included where pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished literature in any language and with any study design was included. DATA COLLECTION AND ANALYSIS Two reviewers abstracted data and the quality of included studies was evaluated by assessing potential attrition, as well as selection and measurement bias, and a Jadad score was obtained. Effects were combined using a random effects model. MAIN RESULTS A sufficient number of studies were available for a quantitative synthesis for fluoxetine, orlistat, and sibutramine. Twenty two randomized controlled trials were included in the review, with a total of 296 participants for fluoxitine, 2036 for orlistat, and 1047 for sibutramine. Pharmacotherapy produced modest reductions in weight for fluoxetine (5.1 kg (95% confidence interval [CI], 3.3 - 6.9) at 24 to 26 weeks follow up; orlistat 2.0 kg (CI, 1.3 - 2.8) at 12 to 57 weeks follow-up, and sibutramine 5.1 kg (CI, 3.2 - 7.0) at 12 to 52 weeks follow-up. Glycated hemoglobin also modestly and significantly reduced for fluoxetine and orlistat. Gastrointestinal side effects were common with orlistat; tremor, somnolence and sweating with fluoxetine; and palpitations with sibutramine. Some studies, using a variety of study designs, were available on other drugs and a significant decrease in weight was noted in three studies of mazindol, one of phenmetrazine, two of phentermine. No studies were identified that fit inclusion criteria for pseudophedrine, ephedra, sertraline, yohimbine, amphetamine or its derivatives, bupropion, topiramate, benzocaine, threachlorocitric acid, sertraline, and bromocriptine. AUTHORS' CONCLUSIONS Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 12 to 57 weeks. The magnitude of weight loss is modest, however, and the long-term health benefits remain unclear. The safety of sibutramine is uncertain. There is a paucity of data on other drugs for weight loss or control in persons with type 2 diabetes.
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Affiliation(s)
- S L Norris
- Division of Diabetes Translation, National Center for Chronic Disease Prevention & Health Promotion, Centers for Control and Prevention, 4774 Buford Highway NE, Mail Stop K-10, Atlanta, GA 30341, USA.
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