Public health initiatives focused on
obesity prevention and lifestyle intervention programmes for patients with
obesity have struggled to contain the
obesity epidemic to date. In recent years,
antiobesity drug therapies have had a limited role in clinical treatment algorithms for patients with
obesity. Indeed, a number of high-profile
antiobesity drug suspensions have markedly impacted upon the landscape of
obesity pharmacotherapy. In this review, we discuss the advent of an increasing array of pharmacotherapeutic agents, which are effective both in inducing
weight loss and in maintaining
weight loss achieved by lifestyle measures. The development of these drugs as
antiobesity agents has followed varying paths, ranging from
lorcaserin, a selective
serotonin agent, exploiting the beneficial central actions of
fenfluramine but without the associated systemic side effects, to
liraglutide, a gut
hormone already used as a
glucose-lowering
drug but with
appetite-suppressant properties, or the novel
drug combination of
phentermine/
topiramate, two 'old' drugs used in lower doses than with previous
therapeutic uses, resulting in an additive effect on
weight loss and fewer side effects. We summarize the key findings from recent randomized controlled trials of these three drugs. Although these agents lead to clinically important
weight loss when used as monotherapy, the use of
antiobesity drugs as adjunctive
therapy post intensive lifestyle intervention could prove to be the most successful strategy. Moreover, a progressive approach to
obesity pharmacotherapy perhaps offers the best opportunity to finally address the
obesity crisis on a mass scale.