Area Editoriale
Antiobesity treatment is recommendedfor selected patients in whom lifestyle modification is unsuccessful. Twoantiobesity drugs are currently licensed for long-term use. Orlistat, agastrointestinal lipase inhibitor, reduces weight by around 3 kg on average and decreasesprogression to diabetes in high-risk patients; adverse gastrointestinal effectsare common. Sibutramine, a monoamine-reuptake inhibitor, results in mean weightlosses of 4-5 kg,but is associated with increases in blood pressure and pulse rate. Rimonabant,the first of the endocannabinoid receptor antagonists, reduces weight by 4-5 kg on average and improveswaist circumference and concentrations of HDL cholesterol and triglyceride;however, an increased incidence of mood-related disorders has been reported. Todate, all antiobesity drug trials have been limited by their high attritionrates and lack of long-term morbidity and mortality data. Other promisingantiobesity drugs, including those acting within the central melanocortinpathway, are in development, but are years away from clinical use. In light ofthe lack of successful weight-loss treatments and the public-healthimplications of the obesity pandemic, the development of safe and effectivedrugs should be a priority. However, as new drugs are developed we suggest thatthe assessment processes should include both surrogate endpoints (ie, weightloss) and clinical outcomes (ie, major obesity-related morbidity andmortality). Only then can patients and their physicians be confident that theputative benefits of such drugs outweigh their risks and costs.Leggil'articolo