Therapy goals
- The first step is to aim for a “metabolically healthy” overweight.
- The goal of therapy with antiadiposita (slimming agents) is to reduce body weight in individuals with a BMI ≥ 30 kg/m².
Therapy recommendations
- Drug therapy for overweight and obesity is not a primary form of therapy. It should be used only when lifestyle changes fail to achieve weight loss or achieve inadequate weight loss:
- Weight loss <5% of initial weight within 6 months.
- Weight gain > 5% of baseline weight within six months after a period of weight loss.
- The antiadiposita (orlistat, liraglutide) are intended as supportive therapy in addition to dietary changes, physical activity and psychotherapy, if necessary.
- Surgical intervention is indicated only in extreme obesity resistant to therapy.
Contraindications for weight loss:
- Pregnancy
- Lactation (relative contraindication)
- Consumptive diseases (eg, malignant tumors, tuberculosis).
- Acute diseases
- Older age (≥ 70 years): indication should be made very critically
- Chronic diseases: Benefits and risks must be carefully weighed against each other
Orlistat
Orlistat belongs to the group of lipase inhibitors. This active ingredient affects the burning of fat in the intestine. The dose for weight loss should be 60-120 mg taken as a capsule before each meal. The most common side effects include increased bowel movements, liquid stools, and abdominal pain. Important notice. Discontinue after 12 weeks unless > 5% of bw has been lost No long-term therapy!
Researchers from the Nordic Cochrane Centre in Copenhagen, who analyzed the final study reports of the individual patients that were the basis of the registration studies, from seven trials, conclude that the side effects of orlisate may have been downplayed.
Liraglutide
Liraglutide is one of the GLP-1 agonists. It is approved for weight-regulating treatment of patients with obesity (BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 with additional risk factors).
Mysimba
Mysimba (naltrexone hydrochloride + bupropion) – see Summary of Product Characteristics.
- Safety data missing! Both the U.S. and European Medicines Agency consider further studies on the safety of Mysimba to be mandatory and have made them a requirement of the approval that has been granted and marketing that has already taken place.
