Obesity

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