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Published: May 29, 2007
Updated: June 30, 2010
These drugs were heralded as the answer to the management of obesity until reports began appearing associating their use with cardiac valvulopathies and primary pulmonary hypertension. These drugs have subsequently been withdrawn from the market.
In 1975, the first publication reporting use of acupuncture in the treatment of obesity appeared in the literature. Several sites on the ear lobe were identified which reduced appetite when stimulated. No clinical benefit of weight loss has, however, been identified.
In 1977, the concept of wiring the jaws together was introduced. Large clinical studies demonstrated a median weight loss of 55 pounds but after four months the weight loss reached a plateau. When the wires were removed, patients regained 100 percent of the lost weight. Many patients failed to lose significant weight as they learned to sip high caloric fluids through straws, defeating the purpose of the wiring. In addition, jaw wiring was associated with aspiration if the patient vomited.
In 1985, the Garren-Edwards gastric bubble was introduced. This was a balloon device placed inside the stomach which, when inflated, acted as artificial food with a sensation of fullness. The FDA initially approved its use as a temporary adjunct to diet and behavior modification for a maximum use of 14 weeks. Subsequent complications with the device, including spontaneous deflation, passage into the small bowel with small bowel obstruction, and erosion through the stomach, and regain of lost weight upon removal of the bubble, led the FDA to withdraw its approval except for research purposes.
Sibutramine is a serotonin-and norepinephrine-reuptake inhibitor. In recent studies it has been shown to result in a mean weight loss of approximately 10 pounds at a dose of 10 mg and 11 pounds at a 15 mg dose, with weight loss achieving a plateau at six months. Side effects include constipation, dry mouth, headache, insomnia, hypertension, and tachycardia. Relative contraindications for the drug include coronary artery disease, arrhythmias, congestive heart failure, and stroke.
Orlistat is a lipase inhibitor and inhibits absorption of dietary fat. Up to 30 percent of dietary fat absorption can be blocked with administration of 120 mg of orlistat with a meal. Unabsorbed fat is excreted in the stool representing the major side effect of the drug -- diarrhea. Data from three randomized, prospective, placebo-controlled trials have been consistent, showing after one year of treatment, about 1/3 more patients treated with 120 mg of orlistat three times a day lost greater than 5 percent of the initial body weight than did those treated with placebo. Twice as many patients treated with orlistat lost greater than 10 percent of the initial body weight than placebo treated patients.
In another study, patients who had lost weight over six months on a low-calorie diet were then treated with orlistat or placebo for one more year. Those who were given orlistat regained significantly less weight than those given placebo.
In summary, results of all drug trials have been disappointing.
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