Anti-obesity

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Anti-obesity ( weight loss drugs ) are agents for the treatment of overweight (BMI 25-29.9 kg · m −2 ) and obesity ( obesity , BMI ≥ 30 kg · m −2 ). They are used in addition, and usually as a second choice, to support non-medicinal measures such as exercise and exercise, diet and lifestyle changes.

A distinction is made in drug treatment:

  • Means that suppress the feeling of hunger or appetite via an action in the central nervous system
  • Means that intervene in the regulation of body weight through signals from the periphery
  • Agents that inhibit the digestion and / or absorption of food components

In addition, there are a number of other drugs with allegedly slimming effects, the effectiveness of which has not been reliably proven.

Appetite suppressants

The effect of the appetite suppressants (anorectics) is based on an inhibition of the hunger center or an influence on the satiety center in the hypothalamus of the brain .

Indirect sympathomimetics and substances that attack the serotonin metabolism

These drugs, such as amfepramone and sibutramine , are rarely or not at all used therapeutically due to severe side effects . The serotonin agonist Lorcaserin is only approved in the United States. The dopamine serotonin norepinephrine reuptake inhibitor tesofensin is under development.

Endocannabinoid Modulators

The only representative of this group developed up to the point of being marketed, rimonabant, is no longer used therapeutically. Serious psychological side effects such as depression and suicidal ideation , which were observed after the market launch, led to the withdrawal of the approval. The development of Otenabant has been discontinued.

Analogues of gastrointestinal hormones

Various hormones released into the blood by fat cells ( leptin ) or from the gastrointestinal tract (e.g. ghrelin , peptide YY , cholecystokinin , glucagon , glucagon-like peptide 1 (GLP-1) and amylin ) are also involved in the regulation of body weight by having a filling or appetite-stimulating effect.

This is where the development of further anti-obesity begins. Analogs of gastrointestinal hormones are already used to treat type 2 diabetes . Because weight loss was also observed in some of the patients in studies on the two GLP-1 analogues exenatide and liraglutide , they are being tested clinically for the treatment of obesity. Further drug candidates are the amylin analogue pramlintide , which is being clinically tested in combination with metreleptin , a recombinant leptin.

Inhibition of the digestion of food components

An inhibitor of fat digestion ( “fat blocker” ) is the drug orlistat , which specifically and long-lasting blocks the gastrointestinal lipases. As a result, the dietary fats present in the form of triglycerides can no longer be broken down into absorbable free fatty acids and monoglycerides . As a result, digestion and absorption of up to 35% of the fats ingested with food are prevented.

Means with allegedly slimming effects

Products in this group are partly on the market as pharmaceuticals and the majority as medical devices or dietary supplements . As a rule, their effectiveness has not been reliably proven.

Satiety-promoting and "fat-binding" agents

The preparations consist of vegetable fibers, highly cross-linked cellulose , collagen from the connective tissue of cattle, or other substances that swell in the stomach when water is absorbed. This is intended to achieve rapid saturation. In some cases, the preparations are also assigned fat-binding properties. They must be taken with enough water to prevent constipation and intestinal obstruction.

Chitosan , a β-1,4-polymer made from D- glucosamine and N-acetyl-D-glucosamine, which is obtained from the shells of crustaceans ( crabs , lobsters , shrimp ), is said to bind dietary fats in the gastrointestinal tract, so that they are excreted undigested and not absorbed.

Herbal drainage and laxatives

Herbal preparations that contain diuretic or laxative ingredients, such as preparations made from birch leaves , bean pods , pickaxe , juniper , nettles or senna leaves cause increased excretion of water or stool. If taken continuously, the agents are hazardous to health.

Individual substances and other herbal preparations

Both various individual substances (e.g. caffeine , L-carnitine , choline , lecithin ) and various mixtures of minerals , vitamins , herbs, algae , enzymes and other herbal extracts are advertised as dietary supplements for weight loss.

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