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Obesity treatments

08/30/99


Drugs: At the pharmacy
The weight-loss drugs approved by the U.S. Food and Drug Administration for the treatment of obesity are designed to decrease the number of calories people take in. Here is a sampling of some of the drugs*:

Generic name:Phentermine
(was widely prescribed in the 'phen-fen' combination)
SibutramineOrlistat
Brand names:Fastin, Adipex-P, Ionamin, othersMeridiaXenical
How it works:Increases availability of brain chemical norepinephrine; inhibits appetiteIncreases availability of brain chemicals norepinephrine and serotonin; inhibits appetiteInhibits the digestive enzyme pancreatic lipase, reducing absorption of fat by the intestine
*Research centers are currently testing the two newest weight-loss medications, sibutramine and orlistat, in combination.

Drugs: In the lab
Pharmaceutical companies are also testing and developing other compounds as possible weight-loss medications. Here is a list of some of those compounds:

  • Leptin, a hormone produced by fat cells and proposed to suppress appetite. Leptin is currently undergoing tests in obese people.
  • Compounds that burn energy to produce heat; for example, drugs that would stimulate body molecules known as uncoupling proteins, or the beta-3 adrenergic receptor. In theory, these compounds would burn extra calories without extra work.
  • Substances that would affect brain molecules known to influence food intake in animals. These include potential drugs that would dampen the effect of NPY, which promotes food intake. Other† potential drugs would stimulate a brain chemical called MC4-R, which would decrease food intake.

  • If new weight-loss medications are discovered, many doctors believe that combining medications that work in different ways will be more effective than giving a single drug.

    Surgery: A last resort

    Vertically banded gastroplasty creates a small stomach pouch. Another procedure that restricts stomach size, laparoscopic gastric banding, is being tested by the FDA.
    The Roux-en-Y gastric bypass involves first creating a small stomach pouch. Then the small intestine is cut and reattached to the pouch so food bypasses the first portion of the small intestine.

    The National Institutes of Health recommends surgeries for weight loss in certain severely obese patients who havenít responded to less-invasive treatments. People with a body mass index (BMI) over 40 (see chart on page 3F), or people with a BMI over 35 with medical complications, are considered candidates for surgeries.
    Two commonly used procedures are the vertically banded gastroplasty and the Roux-en-Y gastric bypass. Both operations are thought to promote weight loss by limiting how much the stomach can hold, and by delaying the emptying of the food into the intestine. Bypass surgery is also thought to decrease the amount of calories absorbed by the intestine.


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