Obesity and current treatment approaches

Obesity, a global health burden, is closely linked to severe chronic comorbidities such as diabetes mellitus, coronary artery disease, hypertension, and other systemic health issues, which are the leading causes of death worldwide. Recent studies have highlighted the causal relationship between unhealthy diets, high in sodium and low in fruits and whole grains, and the rising prevalence of obesity. With half a billion people affected globally and accounting for 4 million deaths annually, obesity management remains a significant challenge. This comprehensive review aims to consolidate recent medical, endoscopic, and surgical approaches for managing obesity and compare their beneficial effects and efficacy on obesity and its long-term comorbidities.

Medical Management

1. Glucagon-like Peptide 1 (GLP-1) Agonists: Long-acting GLP-1 agonists, including semaglutide, liraglutide, and tirzepatide, have demonstrated significant weight loss in clinical trials. Semaglutide, in particular, has shown superior efficacy to liraglutide, both orally and subcutaneously administered, with weight loss ranging from 4.2% to 15.4% depending on the dosage and mode of administration. Tirzepatide, a newer dual GLP-1 receptor agonist, has also shown promising results in reducing body weight in type 2 diabetes mellitus patients.
2. Orlistat: As a reversible inhibitor of gastrointestinal lipases, orlistat, combined with lifestyle modifications, has contributed to weight loss and reduced the risk of diabetes mellitus. However, its high gastrointestinal side effects and drug interactions limit adherence.
3. Lorcaserin: Lorcaserin, a serotonin 2C receptor agonist, showed modest weight loss and sustained effects in clinical trials. However, concerns regarding increased cancer incidence led to its withdrawal from the market.
4. Combination Therapies: Combination pharmacotherapy, such as the co-administration of pramlintide and phentermine, exenatide and dapagliflozin, and naltrexone/bupropion, has shown enhanced efficacy and long-lasting effects compared to monotherapies.

Emerging Therapeutic Approaches

1. Probiotics: Modulation of gut microbiota through probiotics has shown promise in weight loss. Experimental studies have demonstrated significant reductions in body weight, adipose tissue, and liver weight with the use of Lactobacillus reuteri and Saccharomyces boulardii.
2. Herbal Supplements: The use of herbal weight loss supplements, such as Garcinia cambogia and conjugated linoleic acid, has gained attention. However, safety concerns and limited efficacy have hindered their widespread adoption.

Surgical and Endoscopic Approaches

1. Bariatric Surgery: Procedures like laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have shown significant weight loss and improvements in comorbidities. Recent advancements in endoscopic sleeve gastroplasty (ESG) and primary obesity surgery endoluminal (POSE) procedures have also demonstrated promising results.
2. Transcatheter Bariatric Embolization (TBE): A novel, minimally invasive procedure, TBE involves the embolization of branches of the gastric artery, resulting in reduced gastric mucosal blood flow and subsequent weight loss.
3. Intragastric Balloon Therapies: Intragastric balloons (IGBs) are temporary devices placed in the stomach to reduce gastric volume and food intake. They have shown significant weight loss, though the effects are typically temporary.

Conclusions

Obesity management requires a multi-modal approach, incorporating lifestyle modifications, pharmacological interventions, and surgical or endoscopic procedures. Current GLP-1 agonists, such as semaglutide, have demonstrated significant weight loss with good safety profiles. Combination therapies are becoming increasingly popular due to their heightened efficacy and long-lasting effects. Novel therapeutic approaches like probiotics, bariatric surgery, and TBE offer promising alternatives for obese patients. Each physician must recognize obesity as a disease and tailor management strategies based on strong evidence, safety profiles, and patient goals. Future research should focus on developing safer, more effective, and sustainable treatment options for obesity and its associated comorbidities.

Full text

https://www.xiahepublishing.com/2994-8754/JTG-2023-00040

The study was recently published in the Journal of Translational Gastroenterology.

Journal of Translational Gastroenterology (JTG) dedicates to improving clinical diagnosis and treatment, advancing understanding of the molecular mechanisms, and promoting translation from bench to bedside of gastrointestinal, hepatobiliary, and pancreatic diseases. The aim of JTG is to provide a forum for the exchange of ideas and concepts on basic, translational, and clinical aspects of gastroenterology, and promote cross-disciplinary research and collaboration.

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