Methods in the treatment of obesity

Abstract

Obesity is a widespread crippling and life-shortening disease that can be defined as a pathologic accumulation of fat reserves. In spite of its epidemic distribution, no fully effective treatments are available. The strategies used for the treatment of obesity have relied mainly on the limitation of energy intake or/and increasing energy expenditure. The most widely used method to limit energy intake has been the use of hypocaloric diets. Their effectivity is limited and fade away rapidly with time. Nevertheless, the sound use of hypocaloric diets is yet the mainstay of the fight against overweight. Inhibition of the absorption of nutrients through specific digestive enzyme inhibitors has been also used. Bariatric surgery is now practically the only fairly effective way to treat the morbidly obese. Conductist conditioning has been used to maintain the obese as far as possible from food, but the results are often poor. However, adequate instruction of the obese on basic nutritional knowledge, and nutritional reeducation are a tool not to be neglected. Exercise is the easiest way to increase energy expenditure. but this increase is only transient; in any case it potentiates the slimming effects of dietary restriction. There are a growing number of drugs used for the treatment of obesity, and more are just being under study and development. The main target of these drugs is to diminish the cravings of appetite as a way to help the obese to limit ingestion, but other drugs tend to increase thermogenesis, easing the consumption of fat reserves; often both effects add up. The most widely studied drugs are serotonergic drugs acting on the brain and adrenergic agents acting both on appetite and heat production. Several hormones, metabolites and even poisons have been postulated as antiobesity agents, but now the most promising areas of study rely on hypothalamic control of appetite, thermogenesis and regulatory control of the mass of fat, the latter achieved through signall