[Pharmacotherapy for obesity]. / Farmacotherapie voor obesitas.

Obesity is a complex endocrine disease, mainly caused by environmental, behavioral and biological factors. Maintaining weight loss is extremely difficult due to the neuro-endocrine dysregulations that stimulate the body to return to the previous, increased, weight. Identifying underlying weight-gaining factors is needed, including medication-related, psychological and endocrine factors, as well as monogenic obesity. The cornerstone of treatment is optimization of lifestyle and all other contributing factors. Achieving at least 5% weight loss already has important health benefits. If combined lifestyle intervention (CLI) alone is not successful, pharmacotherapy or bariatric surgery can be added for patients with increased weight-related health risks. Recently, novel pharmacotherapy became available, among which, liraglutide 3 mg and the combination therapy naltrexone/bupropion, which leads to an additional 5-6% mean weight loss compared to CLI alone. For rare forms of obesity there are specific drugs that target defects in the regulation of hunger and satiety. Promising new pharmacotherapy for obesity is under development.

Extremal dynamics and the approach to the critical state: experiments on a three dimensional pile of rice.

The evolution of the growth of a ricepile is studied in three dimensions. With time, the pile approaches a critical state with a certain slope. Assuming extremal dynamics in the evolution of the pile, the way the critical state is approached is dictated by the scaling properties of the critical state itself. Experimentally, we determine the envelope of the maximal slope, which is a measure for the distance from the critical state, as well as the growth of the average avalanche size with time. These quantities obey power-law scaling, where the experimental exponents are in good agreement with those obtained from an earlier determination of the critical state properties and extremal dynamics. Furthermore, we discuss the influence of the transient state on the avalanche size distribution, which may have applications in the prevention of large avalanches in natural systems.