Obesidade : ainda sem a cura, mas necessitando de conhecimento, cuidados e comprometimento

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Recent progress and novel perspectives on obesity pharmacotherapy

O aumento da prevalência da obesidade, nas últimas décadas, é alarmante, o que implica um grande número de pacientes sob risco de complicações metabólicas e cardiovasculares associadas. A eficácia modesta a longo prazo das modificações de estilo de vida isoladamente exige a necessidade de intervenções mais agressivas, seja por meio do uso adjuvante de medicamentos ou da abordagem mais radical cirúrgica. A cirurgia bariátrica, embora até hoje tenha se mostrado o método mais efetivo de tratamento dessa enfermidade, pode estar associada a complicações nutricionais e metabólicas ainda não totalmente esclarecidas. Contrasta com esse fato a disponibilidade limitada de agentes antiobesidade atualmente no mercado, além de fatos históricos que envolveram a suspensão de alguns fármacos previamente existentes, por questões de segurança. Este artigo tem como objetivo apresentar dados recentes de estudos clínicos de novas drogas propostas para o tratamento da obesidade com perspectivas breves de serem lançadas no mercado, caso passem pela aprovação das agências regulatórias. Nesta revisão serão discutidas a eficácia e a segurança desses fármacos, que incluem a lorcaserina (agonista serotoninérgico seletivo 5-HT2c), tesofensina (inibidor triplo de recaptação de monoaminas), liraglutide (análogo do GLP-1) e cetilistate (inibidor de lipases gastrointestinais), além das combinações de bupropiona/naltrexona, bupropiona/zonisamida, fentermina/topiramato e pramlintide/metreleptina.Obesity prevalence has risen dramatically over the past decades, which poses a great number of patients at risk of metabolic and cardiovascular complications. Long-term efficacy of lifestyle modification isolated has shown to be modest which, therefore, urges the need of more aggressive interventions such as adjuvant pharmacotherapy or the more radical surgical approach. Bariatric surgery has proven to date to be the most effective treatment, although it may be associated with nutritional and metabolic complications not yet completely recognized. By contrast, there is limited availability of antiobesity agents currently in the market, as well as historical facts involving the suspension of previously existing medications due to safety concerns. This article aims to present recent data on clinical trials of novel weight-loss drugs with short perspective to enter the market, if approved by the regulatory agencies. This review will discuss the efficacy and safety of these compounds, which include lorcaserin (selective serotonin 5-HT2c agonist), tesofensine (triple monoamine reuptake inhibitor), liraglutide (GLP-1 analogue) and cetilistat (gastrointestinal lipase inhibitor), as well as the combination therapies of bupropion/naltrexone, bupropion/zonisamide, phentermine/topiramate and pramlintide/metreleptin

Efficacy and Tolerability of the Association of Sibutramine and Orlistat for Six Months in Overweight and Obese Patients

Objective. To assess the efficacy and tolerability of the association sibutramine (10–20 mg/day) and orlistat (120 mg 2-3 times a day) in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (−9.8% of the initial weight, n = 263), and after 6 months, the mean weight loss was 13.9 kg (−12.8% of the initial weight, n = 97). The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately

Characterization of metabolic resting rate and proposal of a new equation for a female Brazilian population

OBJETIVOS: Os objetivos do estudo foram normatizar o gasto metabólico de repouso (GMR) de mulheres brasileiras, avaliar a adequação da fórmula de Harris Benedict (HB), a relação entre suas variáveis e propor novas equações para estimativa do GMR. SUJEITOS E MÉTODOS: Para tanto, foram utilizados 760 exames de calorimetria indireta (CI) de mulheres com idade entre 18 e 65 anos. Os resultados foram tabulados, a população foi dividida de acordo com quintis de peso e, então, realizaram-se as análises estatísticas. RESULTADOS: A média de GMR variou entre 1.226 calorias/dia a 1.775 calorias/dia. A fórmula de HB superestimou o GMR em torno de 7%.Concluímos, a partir da correlação entre as variáveis, que o peso possui correlação positiva com o GMR, e a idade, uma correlação negativa. CONCLUSÃO: GMR assim como coeficiente respiratório (QR) podem ser utilizados como preditores de obesidade. Nosso estudo trouxe duas novas propostas de equações, uma para a população com índice de massa corpórea (IMC) &gt; 35 kg/m² e outra para a população com IMC < 35 kg/m².OBJETIVES: The goals of this study were to standardize resting metabolic rate (RMR) in the Brazilian female population and evaluate the suitability of the HB equation. SUBJECTS AND METHODS: In order to do so, 760 indirect calorimetry (CI) measurements performed in Brazilian female patients between 18 and 65 years old, were used. The results were tabulated, the population distributed according to the quintiles of weight, and the statistical analyses applied. RESULTS: The average RMR varied from 1,226 to 1,775 calories/day. The HB equation overestimated the RMR by about 7%. From the correlation between the variables, we conclude that weight has a positive correlation with RMR and age a negative correlation. CONCLUSION: The RMR and respiratory quotient (QR) can be used as obesity predictors. Two new equations were proposed in our study, one for the population with body mass index (BMI) &gt; 35 kg/m² and another for the population with BMI < 35 kg/m²

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life

Metabolic syndrome in children and adolescents - criteria for diagnosis

In recent years, there has been a greater concern about the presence of obesity and metabolic syndrome in children and adolescents. However, there is no consensus regarding the diagnosis of metabolic syndrome in children and adolescents. It is evident that each component of the syndrome must be identified as early as possible in order to prevent definitive lesions. The question is how to do this and which cut-offs must be adopted for this diagnosis. For a matter of convenience, the definition chosen as the most appropriate is the one proposed by the IDF, with cut-offs fixed for pressure, lipids and glycemia, and abdominal circumference points assessed by percentile. Although on the one hand this definition could fail to include some children in the diagnosis of Metabolic Syndrome, on the other hand, it would be of easier acceptance as it does not use multiple tables to assess several anthropometric and metabolic criteria

The effects of exercise training in a weight loss lifestyle intervention on asthma control, quality of life and psychosocial symptoms in adult obese asthmatics: protocol of a randomized controlled trial

Abstract\ud \ud Background\ud Asthma and obesity are public health problems with increasing prevalence worldwide. Clinical and epidemiologic studies have demonstrated that obese asthmatics have worse clinical control and health related quality of life (HRQL) despite an optimized medical treatment. Bariatric surgery is successful to weight-loss and improves asthma control; however, the benefits of nonsurgical interventions remain unknown.\ud \ud \ud Methods/Design\ud This is a randomized controlled trial with 2-arms parallel. Fifty-five moderate or severe asthmatics with grade II obesity (BMI ≥ 35 kg/m2) under optimized medication will be randomly assigned into either weight-loss program + sham (WL + S group) or weight-loss program + exercise (WL + E group). The weight loss program will be the same for both groups including nutrition and psychological therapies (every 15 days, total of 6 sessions, 60 min each). Exercise program will include aerobic and resistance muscle training while sham treatment will include a breathing and stretching program (both programs twice a week, 3 months, 60 min each session). The primary outcome variable will be asthma clinical control. Secondary outcomes include HRQL, levels of depression and anxiety, lung function, daily life physical activity, body composition, maximal aerobic capacity, strength muscle and sleep disorders. Potential mechanism (changes in lung mechanical and airway/systemic inflammation) will also be examined to explain the benefits in both groups.\ud \ud \ud Discussion\ud This study will bring a significant contribution to the literature evaluating the effects of exercise conditioning in a weight loss intervention in obese asthmatics as well as will evaluate possible involved mechanisms.\ud \ud \ud Trial registration\ud \ud \ud NCT02188940The study was supported by the São Paulo Research Foundation (FAPESP;\ud Grants 2012/16700-9 and 2012/16134-3) and Conselho Nacional de Pesquisa (CNPq Grants 485065/2012-6)

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection