Approved Anti-Obesity Medications in 2022 KSSO Guidelines and the Promise of Phase 3 Clinical Trials: Anti-Obesity Drugs in the Sky and on the Horizon

Abstract

Obesity is a prevalent global health issue affecting approximately half of the world' s population. Extensive scientific research highlights the urgent need for effective obesity management to mitigate health risks and prevent complications. While bariatric surgery has proven to be highly effective, providing substantial short-term and long-term weight loss and resolution of obesity-related comorbidities, it is important to recognize its limitations and associated risks. Given the global obesity epidemic and the limitations of surgical interventions, there is high demand for effective and safe anti-obesity medications (AOMs). In Korea, the Korean Society for the Study of Obesity strongly advocates for the use of pharmacotherapy in Korean adults with a body mass index of 25 kg/m² or higher who have not achieved weight reduction through non-pharmacological treatments. Currently, five AOMs have been approved for long-term weight management: orlistat, naltrexone/bupropion, phentermine/ topiramate, liraglutide, and semaglutide. Tirzepatide is awaiting approval, and combination of semaglutide/ cagrilintide and oral semaglutide are currently undergoing rigorous evaluation in phase 3 clinical trials. Furthermore, other promising drugs, including orforglipron, BI 456906, and retartrutide, are progressing to phase 3 studies, expanding the therapeutic options for obesity management. In personalized patient care, physicians play a crucial role in accurately identifying individuals who genuinely require pharmacotherapy and selecting appropriate AOMs based on individual patient characteristics. By integrating evidence-based interventions and considering the unique needs of patients, healthcare professionals significantly contribute to the success of obesity management strategies.

Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes

“…Semaglutide induces weight reduction through delayed gastric emptying and hypothalamic GLP-1 receptor-mediated appetite suppression [ 20 ]. On the other hand, semaglutide administration is often accompanied by gastrointestinal symptoms such as nausea, constipation, and gastroesophageal reflux disease [ 27 ].…”

“…Weight reduction induced by GLP-1 analogs such as semaglutide is not solely attributed to body fat, but may also involve skeletal muscle [ 29 ]. In another study, treatment with GLP-1 analogs decreased appetite for and intake of high-fat foods such as meat, but did not decrease intake of low-fat, sweet foods such as fruits and cereals [ 20 ]. In this study, the protein ratio decreased significantly, and serum albumin, vitamin B12, and zinc decreased during semaglutide treatment, suggesting that the intake of meat, which is rich in these nutrients, may have decreased, resulting in lower animal protein intake and reduced skeletal muscle mass.…”

“…Postoperative FD also may be effective to prevent protein deficiency and skeletal muscle mass loss after LSG [ 6 ]. On the other hand, semaglutide has adverse effects such as delayed gastric emptying and appetite loss [ 20 ], which may affect nutritional intake and body composition. Administration of semaglutide to patients after bariatric surgery may affect their measured nutritional metrics.…”

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

“…The other obesity treatment that is rapidly gaining traction is pharmacotherapy, either as standalone treatment or as adjuvant therapy following bariatric surgery. Although previous results with various antiobesity medications have been largely disappointing, much better weight loss and comorbidity control are being seen with newer agents mainly from the glucagon-like peptide-1 agonist family 74,75 . Although these agents are not likely to cause an emergent surgical presentation, they do significantly delay gastric emptying and likely increase aspiration risk perioperatively 76,77 .…”

Güncel Anti-Obezite İlaçları Glukagon benzeri peptid-1 (GLP-1) Reseptör Agonistleri ve Etki Mekanizmaları

“…Bunun üzerine, bu ilaçların etiket grubu, "kilo vermeye yardımcı ilaçlar" yerine "anti-obezite ilaçları" olarak değiştir FDA tarafından güncellenmiştir. Ek olarak, wegovy'nin yaşam kalitesi ve hasta sonuçları üzerindeki etkisinin değerlendirildiği uzun vadeli çalışmalara halen ihtiyaç bulunmaktadır [18][19][20][21].…”