how and when to use them

Last June, the media announced the existence of a drug capable of producing a loss more than 20% by weight in obese patients. Called tirzepatidehas woken up public interest for this type of compound.

However, the use of overweight drugs It’s not new. Although the basis of any treatment is a low-calorie diet associated with physical exercise, there have also been molecules for decades that help reduce excess pounds.

Currently, there are three drugs available in Spain that have proven their effectiveness. On the one hand, orlistat, nail molecule oral administration which reduces the intestinal absorption of fats from food. can reduce up to 4% of starting weight.

[El ‘padre’ español del fármaco para perder hasta 24 kg: “Se vuelven a poner el traje de boda”]

On the other hand, there is the naltrexone. He is opioid antagonistused in the alcoholism treatment and to prevent relapse of opiate use, it is combined with bupropionused antidepressant against smoking. The joint action of the two reduces the appetite and makes it possible to obtain losses of 5% of body weight on average.

Finally, there is the liraglutide. Daily subcutaneous administration, mimics the effect of GLP-1 (Glucagon-Like Peptide-1). This intestinal peptide, which is synthesized in response to the presence of food in the digestive tract, stimulates insulin secretion through the pancreas after meals. Another peptide participates in the process, GIP (Glucose-dependent Insulinotropic-Polipeptide). GLP-1 and GIP too generate a feeling of satiety by acting on a region of the brain called the hypothalamus. Patients who are prescribed lose up to 7% by weight.

the next arrivals

In addition, in the coming months, we can expect the incorporation of other drugs from this last group, called incretin-incretin mimetics. An example is semaglutidewhich is administered subcutaneously weekly and has shown weight reductions of up to 14%.

As for tirzepatidethe molecule which has recently attracted attention, has a double acting: acts simultaneously on the cerebral receptors of incretins GLP-1 and GIP, regulating the sensation of appetite. It is also expected to be available in Spain in the medium term, along with other molecules currently in development.

[Casi dos de cada tres adultos tiene sobrepeso u obesidad en Europa: la alerta de la OMS]

However, it should be considered that drugs to treat obesity they are not harmless. Although orlistat can cause flatulence and faecal incontinence, naltrexone/bupropion sometimes causes nausea, constipation, headache, and insomnia, and should not be given to people with certain psychiatric conditions .

The incretins (liraglutide, semaglutide and tirzepatide) have variable efficacy: in some people they produce significant effects and in others they are completely ineffective. In addition, they cause nausea and vomiting and are contraindicated in people with diseases of the pancreas.

When should they be used?

Although they can be a big help, drugs are still a complement in the treatment of obesity. The physical activity is particularly relevant, since both drugs and diet They also decrease body water and muscle mass. Only exercise can preserve muscle and lose weight primarily at the expense of fat.

[Doctora Malagón, la sabia de la obesidad: “Adelgazar no es solo una cuestión de voluntad”]

It should be emphasized that the treatment of obesity should be carried out under medical supervision. Among other factors, it will take into account the body mass index (BMI), which is calculated by dividing a person’s weight (in kilograms) by their height (in meters) squared. The drug use may be appropriate when BMI is equal to or greater than 30 kg/2; or if it is greater than or equal to 27 kg/m2; Yes the person has diabetes, hypertension or high cholesterol.

Currently, we do not have any drugs that have shown losses greater than 20% of body weight. In cases where it is necessary to make higher descents, the gastrointestinal surgery It is a therapeutic option. It is indicated when the BMI is equal to or greater than 40 kg/m2; or in the event of a BMI equal to or greater than 35 kg/m2; if the patient suffers from diabetes, hypertension or hypercholesterolemia.

When asked if there is a treatment to lose weight without change lifestyle, The answer is no. Medication and surgery can be a good complement to diet and exercise in some cases of obesity, but they alone do not solve this pathology.

The conversation

*Manuel Penin Alvarez is thspecialist in endocrinology and nutrition at SERGAS Servizo Galego de Saúde.

*Federico Mallo Ferrer is cProfessor of Physiology-Endocrinology, at the Biomedical Research Center-University of Vigo.

**This article was originally published on The conversation.

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