OBESITY

Updated: May 18

Could this new study mark the beginning of the end of the obesity crisis?


As obesity prevalence rises worldwide, many countries feel the "weight" of its economic impact on the healthcare system. There is too high of costs in treating obesity and its predispositions like Cardiovascular disease, type 2 Diabetes Mellitus, hypertension, and many others [1]; this is more concerning in developing countries as Childhood obesity is 30% higher than in developed countries [2]. A complex condition like obesity has to be approached differently. It's not just the consequence of a bad lifestyle; Its complexity is due to multifactorial causes such as genetic, socioeconomic, and environmental factors [1].

 

Regarding the treatment of obesity, few options exist besides the more conventional "low-calorie diet " and the casual " new workout program". These methods should work in theory, as putting a patient on a caloric deficit should help them lose weight over time, but the maintenance of this weight loss proves to be more challenging. The odds are not in the patient's favor in maintaining the weight loss progress [3]; this is due to an obesogenic environment that gives less access to cheaper and unprocessed food [4][5][6]. The patient also has less time and fewer opportunities to do physical activities as jobs become more sedentary. In suburban areas, they are more uses for vehicles as transport than physical activities such as walking or biking [7].


Patients will also have to fight their bodies with the declining energy expenditure, which is not usually regarded in weight loss programs [8].Weight loss will trigger negative feedback mechanisms, which will also increase food intake by increasing appetite and reducing satiety [8][9]. More importantly, Heathcare professionals have to recognize that they can not blame the

failure to maintain weight loss on the patient's lack of effort or adherence, which could lead to further stigmatization of patients who are overweight or obese [10], which perpetuates a bias that may cause misdiagnosis and mistreatment [11].


Phentermine and Topiramate have been marketed separately since 1959 and 1996 in the US, respectively. Only in 2012 were they approved to be used in combination with each other by the FDA, accompanied by a diet and exercise program [12]. Phentermine is a sympathomimetic amine anorectic that stimulates the release of norepinephrine and epinephrine, while topiramate causes appetite suppression and increases the feeling of satiety [13][14]. A new study on adolescents at the University of Minnesota medical school, conducted by Dr. Kelly et al., shows a statistical reduction in adolescents' BMI and a positive impact on the triglyceride and HDL-C levels [15]. This drug could be effective in the long-term maintenance of weight-loss.


Table 1: Percent Body-Mass Index Change Over Time.


There is no fit all approach in the treatment of obesity, but a combination approach that will include anti-obesity drugs with diet and exerci