Obesity: Lifestyle management, bariatric surgery, drugs, and the therapeutic exploitation of gut hormones

Abstract

Obesity is on the rise and the pursuit of efficient and safe treatment is ongoing. Available anti-obesity medical therapies have so far proved to be disappointing, whereas bariatric surgery is leading the way and offers long-term health benefits. Part of the success of bariatric surgery is thought to be mediated by gut hormones. A better understanding of the role of gut hormones within the gut-brain signaling pathway in the control of hunger, satiety, and energy homeostasis, has led to their therapeutic exploitation as possible anti-obesity drugs. In this review, we provide a summary of currently available treatment options for obesity from simple lifestyle modifications and bariatric surgery to traditional and novel medical therapies.

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

“…105 Presently, the most commonly performed bariatric surgeries are laparoscopic adjustable gastric banding, Roux en-Y gastric bypass, and laparoscopic sleeve gastrectomy. 106 However, there have been growing concerns about side effects induced by these surgical techniques, including stenosis at the anastomosis site, stomal ulcer, fistula, band erosion, and motor dysfunction of the esophagus, stomach, and small bowel among others.…”

Is bariatric surgery the answer to urinary incontinence in obese women?

“…The number of UI episodes decreased by 47% in the intervention group, as compared with 28% in the control group. The investigators concluded that “ a decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction .“ However, as with any other lifestyle intervention, long‐term adherence to diet, exercise, and/or behavior modifications is usually poor, and currently, bariatric surgery is the most effective intervention to achieve significant long‐term weight reduction …”

“…Most recently, the American College of Physicians (ACP), using both previously published clinical data and the ACP's grading system, strongly recommended “ weight loss and exercise for obese women with UI ( Grade : strong recommendation , moderate‐quality evidence ).” However, as with any other lifestyle intervention, clinical outcomes of behavioral weight‐loss programs depend on various factors, such as severity of symptoms, self‐motivation, social support, medical status, etc. Consequently, long‐term adherence to such programs is usually poor, and currently bariatric surgery is the most effective treatment for significant and sustained weight loss . It is recommended for class 2 obesity associated with comorbidities and for class 3 obesity (body mass index [BMI] 35–39.9 kg/m 2 and >40 kg/m 2 , respectively)…”

Redox modulation of adipocyte differentiation: hypothesis of “Redox Chain” and novel insights into intervention of adipogenesis and obesity

“…Epigenetic regulations, such as DNA methylation [3], histone modifications [4,5], chromatin remodeling [4,5] and microRNA regulation [6,7], are sensitive to redox modulation. In turn, epigenetic alterations may influence redox state [8,9].…”