Obesity
From IDWiki
Background
- Obesity is a chronic relapsing condition
Management
Pharmacotherapy
- Semaglutide (Ozempic)
- GLP-1 analogue, so essentially sends a satiety signal
- Not the oral version; the subcut version is required for it to cross the blood-brain barrier and have the desired effect
- Target dose is 2.4 mg/week (higher than for diabetes)
- In STEP 4 trial, lost 8% of body weight, with decreased waist circumference and blood pressure, up to 48 weeks
- GI side effects are common
- In the future, look out for combination treatment with GIP analogues
- Bupropion/Naltrexone (Contrave)
- Bupropion stimuates POMC cells, suppressing appetits, and naltrexone blocks β-endorphin negative feedback loop which would otherwise prevent bupropion from having its intended effect
- About 30% of patients lost 10% body weight
- Orlistat
- Poorly tolerated due to diarrhea
- Bariatric surgery
