Farmacos
For the obesity?
The farmacological treatment of the obesity has to consider
when it can not attain a loss of weight of 10% with the therapy of diet
and the physical activity. The effective medicines in the treatment of the obesity can act by different mechanisms such as the reduction of the consumption of foods, the inhibition of the absorption of fats, the increase of the termogénesis and the stimulation of the apoptosis of the adipocytes. At present, only we have two medicines commercialised for the treatment of the obesity.
So that the treatment of the obesity was successful, the patient has to accept continue the medical treatment and the therapy of exercises, as well as the treatment with medicines and the examinations and examinations of regular health.

The administration of sibutramina during a year can induce a loss of weight of the 4-7%.
The secondary effects are hipertensión, headache, sleeplessness and constipation. Orlistat Is an inhibidor of the pancreatic lipase that it can block the absorption of 30% of the fat ingerida. His administration induces the loss of weight and the reduction of the recovery ulterior of the weight.


The increase in the frequency of the depositions and the interference with the absorption of vitamins are his main secondary effects.
The similar peptide to the glucagón 1, that increases the sensitivity to the insulin and the satiety, the adiponectina and the agonistas of PPAR-gamma that reduce the resistance to the insulin and modulates the generation of adipocytes are the base of future therapeutic approaches of the obesity.
The inhibidores of the fosfatasa induce the phosphorylation of PPAR-gamma and the expression of UCP-1 that drives to an increase of the termogénesis and the reduction of the appetite. .

The current farmacological treatments are not totally acceptable because of his little security and efficiency.
The obesity also associates with other grave complications, as diabetes mellitus, hipertensión, hiperlipidemia, hipercolesterolemia, cardiovascular illnesses, etc.
Because of his complex nature, exists the need of a farmacological treatment on a long-term basis safe and effective. An approach of treatment is not sufficient to administer the complex pathological circuit of the obesity. Recently, they have proposed several new aims that control the energetic homeostasis and warn the obesity.
Although the newest medicines are very far of the clinical use, the hope to realise investments of investigation to date is the translation to a safe farmacological treatment and effective in the future.
Farmacological
treatment of the obesity?
The obesity now presents one of the greater problems of health
of our time.The diet and the exercise are better so much for the prevention as for the treatment; unfortunately, both require a lot of discipline and are difficult to keep.


This document reviews the medicines that are available for the treatment of the obesity, included many of the recently take# out of the market.
Also it analyses some of the newest treatments that are investigating at present.
The obesity has turned into one of the greater problems of health of our times. The last projections of the World Health Organisation (WHO) indicated that to world-wide level in 2005, roughly 1.600 million adults had sobrepeso and at least 400 millions were obese. The WHO projects besides that for the year 2015 roughly 2.300 million adults will have sobrepeso and more than 700 millions will be obese. At least 20 million lower boys of 5 years had sobrepeso in 2005
Although the obesity has been labelled like an illness by more than 200 years, only recently has recognised like a condition that deserves medical attention.
The obesity associates with osteoartritis, obstructive apnoea of the dream, increase of the risk of cancer and hepatic illness fat no alcoholic.
It is related with a variety of other complications, like the illness by backflow gastrointestinal, drop, headache, celulitis, chronic renal insufficiency, hipogonadismo and dysfunction eréctil, among others. On the other hand, the obesity associates with a reduction of the quality of life and the social stigmatisation.

This low implication by part of the doctor can have to, partly, to the fact that in this moment still does not exist a magic formula for the treatment of the obesity, and the diet and the exercise continue being the angular stone of the treatment. Given the frustrations that confront the doctors and the patients to attain results by means of the diet and the exercise, the therapy with medicines offers an attractive option, even if the results are modest. Unfortunately, in spite of the frantic research in this moment of farmacoterapia, at present exist few options.
In the last years, a lot of medicines that have been effective to go down of weight have had to be withdrawn of the market because of unacceptable secondary effects.

Indications
for the medical therapy?
The obesity defines like an index of corporal mass (IMC, calculated like the weight in kilograms divided by the square of the height in metres) of 30 or more.
The guides of clinical practice for the handle farmacological and surgical of the obesity in primary attention have been published by the American College of Physicians (ACP) [10].







It is possible that these recommendations change prompt, to the light of the new findings that relate to the sibutramina with a greater tax of cardiac events . The NIH also suggests that the adults with an IMC> 35 that have comorbilidades grave like diabetes, apnoea of the dream, miocardiopatía related with the obesity or severe articular illness also can be candidates for the surgery bariátrica.
You put
of the therapy of Obesity?
Perhaps the most important appearance to initiate the farmacological treatment for the obesity is to establish realistic aims.
Given the difficulties of the diet, is almost impossible to reach the expectations of the patients. Numerous studies have showed that the obese people want to lose the equivalent to the 25-35% of his initial weight and expect to do it in roughly 1 year of treatment .
The people that do diet keep these expectations even when it informs them reiteradamente that is likely that lose only a 5-15% of the initial weight, that is the size of the typically induced losses by the interventions conductuales and farmacological current .
These data illustrate the dramatic disparity between the expectations of the patients and the professional recommendations and the need to help to the patients to accept results of loss of weight more modest.

If this does not attain , then the dose has to adjust or suspend the medicine. Although the loss of weight is an important result of the treatment, a main aim of the treatment of the obesity would have to be improve the factors of cardiovascular and metabolic risk to reduce the morbilidad and the mortality related with the obesity.

The patients that have intolerance to the glucose, diabetes type 2 or hipertensión are those that more benefit regarding the improvement of the factors of cardiovascular risk .
When initiating the farmacological therapy, is important that the patient comprise that once that it attains the therapeutic effect maximum, stabilises the loss of weight and that when it interrupts the farmacological treatment, recovers the weight .
Due to the fact that the body reduces his expense of energy to measure that loses weight, has to do more and more effort to keep the loss of weight . The increase of weight is the result of complex interactions between multiple factors, included physiological factors, environmental and psychological. The physiological factors include the reduction of the metabolic tax, so much in rest as in rest , and a greater activity of the lipoprotein lipase of the adipose fabric.
These mechanisms contrarreguladores protect against the starvation when causing an increase in the appetite and a decrease in the expense of energy, what does that it was very difficult to keep the stray weight. The patients also have to be conscious of the fact that the data on the use of these medicines are limited, since the longest essays for the sibutramina have a length of alone two years, and for orlistat a maximum of four years.
The essays for the remaining medicines are even more short. Therefore, if there is a good answer to the medicine and the patient wishes to continue, the decision has to be a discussion shared between the doctor and the patient.
?Medicines
for the loss of weight?



The fentermina is the medication to go down of weight recetada with more frequency. The fentermina administered of continuous form in a blind double essay of 36 weeks in 108 women caused a loss of 12,2 kg, in front of placebo, that went of 4,8 kg


It diminishes the glucose in blood when inhibiting the secretion of glucagón and stimulate the secretion of insulin. GLP-1 also delays the gastric casting, reduces the consumption calórica and promotes the satiety. Exenatide (Byetta) Is an agonista of the receptor GLP-1 that shares a homology of 53% with GLP-1 and has a semivida much longer because it is resistant to the degradation mediated by dipeptidil peptidasa-4- (DPP-4).
It administers like injection subcutánea twice a day. It is approved to treat the diabetes type 2 and produces similar effects to the GLP-1, reducing the levels of glucose in ayunas and posprandiales, diminishing the HbA1c, diminishing the gastric casting and diminishing the consumption of foods in roughly 19%.

It has showed that the amilina diminishes the gastric casting, reduces the increases posprandiales in the concentrations of glucose in blood and improves the concentrations of hemoglobin To1C in patients with diabetes type 1 and type 2. It has to administer by injection subcutánea, to a maximum dose of 120 microgramos with each food. Pramlintide Associates with a loss of weight moderated in patients with diabetes type 1. In one of these essays, where 651 patients with diabetes type 1 were assigned randomly to placebo or pramlintide subcutáneo in addition to to his insulin, the weight diminished 0.4 kg in the group pramlintida and increased in 0.8 kg in the group placebo .



It observed loss of weight in the clinical essays for the treatment of the epilepsy [85], what caused an essay of obesity.


Besides, the increase of weight after the treatment to quit smoking was minor in the subjects treated with bupropión SR that in the subjects treated with placebo.



A possible use of the leptina can be a complementary therapy for the maintenance of the loss of weight.
The reductions in the expense of energy and the concentrations of hormone tiroidea that occur with the loss of weight can be due to a descent in the concentrations of leptina and also can hinder the capacity to keep the loss of weight.





?Treatments combined?
Any of the medicines of only agent that have been approved or that seem
to be next to the approval has been consistentemente able to attain a loss
of weight of more than roughly 10% of the corporal weight. The combination of fentermina and fenfluramina, that withdrew of the market in 1997, was able to attain a loss of roughly 15% of the corporal weight.
Recognising the complex pathophysiology of the obesity, the recent efforts have centred in therapies combined. The use of more than a medicine to treat the obesity is similar to the treatment of the hipertensión, where often need several medicines to reach the aims established.

The obesity now presents one of the greater problems of health of our time. The diet and the exercise are better so much for the prevention as for the treatment; unfortunately, both require a lot of discipline and are difficult to keep.
The medicines offer a possible complement, but his effect is modest, are limited by the secondary effects and the loss of hard weight only while it takes the medicine, since so prompt as it interrupts the treatment, recovers the weight. The sibutramina, a medication simpaticomimética that was available for the treatment on a long-term basis, is the most recent of the drugs that will withdraw of the market because of the secondary effects; in this case, it went a greater risk of cardiovascular events.
They exist other available medicines, but is to expect that learn more on the combination of existent medicines and the development of new medicines provide a better treatment for this so difficult challenge.

