OpiniOn | WEIgHTMAnAgEMEnT |
obesity T
surgical approaches to
PETER CHARLISH Principal Analyst,
as we continue to face the obesity epidemic, Peter Charlish investigates the appeal and use of gastric bands to combat the problem
Informa Business Information email:
peter.charlish@
informa.com
he disTurbing facTs about
the worldwide
epidemic of overweight and obesity hardly needs repeating: according to the World health Organization
(WhO) 1 , approximately 1.6 billion adults
were overweight in 2005, and at least 400 million were obese. and that doesn’t include the 20 million or more children globally who were overweight in 2005. by 2015 — the WhO predicts — approximately 2.3 billion adults will be overweight, and more than 700 million obese. Overweight is usually defined in terms
of body mass index (BMI); the ratio of weight in kilograms to the square of the height in metres. Men are described as overweight when their BMI is 25 or more, while obesity equates to a BMI of 30 or higher. The thresholds for women are slightly lower. The health consequences of being
overweight are also well known. It is a known risk factor for cardiovascular disease, especially ischaemic heart disease, hypertension and stroke; diabetes mellitus; hiatus hernia; gallstones; musculoskeletal conditions such as osteoarthritis; and certain forms of cancer. In the final analysis, overweight and
obesity are the result of an imbalance between calorie intake and energy
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expenditure. The inexorable rise in the number of overweight people reflects the trend towards increased intake of calorie‑rich foods that are high in fat and sugar (and low in vitamins and other nutrients), coupled with decreased levels of physical activity as a result of changing patterns of work, transportation, etc.
Combatting the problem So what can be done? Patients are frequently encouraged to increase their physical activity, and certainly this will help redress the energy imbalance. However, obese patients may have restricted mobility, and walking is often the only activity they can comfortably contemplate. Walking burns relatively few calories, so this type of exercise alone is unlikely to be a complete solution (although it may help improve some of the consequences of overweight). Therefore, the only realistic way for an
obese individual to lose weight is to restrict calorie intake. It is important for the patient to realise that prolonged dieting is necessary for large amounts of fat to be lost, and that a permanent change in eating habits is essential. Some patients find this type of regimen
difficult to follow, and in such cases, some sort of medical intervention, either physical or pharmacological, may be
September 2011 |
prime-journal.com
warranted. While drugs that effectively reduce appetite are available, they tend to have undesirable side‑effects — in the past couple of years, for example, sibutramine (known variously as Meridia or Reductil) has been withdrawn from many markets because of an increased risk of cardiovascular events, such as heart attack or stroke. A number of classes of anti‑obesity
agent are currently undergoing evaluation, although the ideal agent remains, for the moment, elusive. One group of compounds that has generated a lot of excitement in recent years is the cannabinoid antagonists, the best‑known example of which is Sanofi‑Aventis’ Acomplia (rimonabant). Although this product has been commercialised in Europe and elsewhere, it has consistently run into trouble with regulators in the US and in fact, was withdrawn from the European market in October 2008 owing to an increased risk of psychiatric disorders. The next new anorectic agent to reach
the market looks likely to be Arena’s 5-HT2C
agonist lorcaserin, which was
submitted for approval to the Food and Drug Administration (FDA) at the end of 2009. Other classes of compounds showing some promise for the obesity indication include the ghrelin antagonists
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