Nutrition from the medical point of view encompasses the understanding of a good initial clinical study, the performance of complementary examinations, such as an exhaustive laboratory and caloric expenditure and body composition studies, to the correct choice and administration of drugs when considered necessary.
The development of pharmacology for obesity had different stages. In 1920, amphetamine and its stimulating effects on the Central Nervous System were discovered. Then its anorectic power (appetite reduction) and the effects of tolerance and dependence were described, with the danger of abuse of these substances.
In the 60’s, its use became widespread in Europe and the United States, being prescribed by countless doctors for the most diverse disorders, resulting in abuse and dependence.
Currently, amphetamine has two indications: attention deficit disorder in children and narcolepsy. The derivatives of amphetamine with anorexigenic actions are: Phentermine, Fenproporex, Diethylpropion.
Mazindol: it is one of the most used anorectics in Argentina, it is allowed by ANMAT with a maximum use of three months, although no dependence phenomena have been found. It is derived from an antidepressant, it is not an amphetamine. Its indications, doses, adverse effects and contraindications are clearly defined in the medical literature. It should be clarified: it is not a natural or homeopathic medication. It can be a master prescription, i.e. by means of a preparation made by a pharmacist.
Orlistat: it inhibits the absorption of part of the fat ingested with food, it does not «dissolve» body fat. It is reasonable to think that in people who have diets with a high fat content, it can be used effectively with this medication, but not in those who consume a low-fat diet. Caution should be taken when supplementing with fat-soluble vitamins (ADEK) because there may be a vitamin deficit with continued use.
Liraglutide: is a synthetic analogue of the GLP-1 hormone, with an action time of about 13 hours. Its main function is to delay gastric emptying and produce satiety at brain level, thus decreasing food intake and possible weight reduction. It can be used in diabetic patients in conjunction with insulin. Side effects may include nausea and diarrhea.
Naltrexone/Bupropion: It is the combination of two drugs: Bupropion is an antidepressant and an opioid antagonist, Naltrexone, commonly used in cases of alcohol dependence. The effect produced is an increase in satiety with a decrease in appetite, thus reducing food intake and impacting in favor of weight reduction. It can be used for prolonged periods of time (1 year and a half in the literature).
Combination Phentermine/Topiramate: Phentermine is an amphetamine anorectic and topiramate an anticonvulsant. It may reduce the craving for binge eating, and may have an effect on increasing caloric expenditure. This combination has been approved in the USA for use in the treatment of obesity for a period of three years. It has not yet been approved in the country.
The use of anti-obesity drugs is framed in the doctor-patient relationship with a mutual commitment of responsibility and trust. And allopathic medicine has solid bases in the use of drugs with good clinical practices (GCP).
Source:
Review of the most widely used drugs in obesity worldwide.
Authors: Raúl Sandro Murray, Marta A. Sánchez, César Casávola, Pablo López Schimpf, Ana L. Cascú, Francisco A. D’Onofrio.Revista SAN. Vol 20 Nº 4 2019.
