Obesity pharmacotherapy - update 2023.

The increasing prevalence of obesity and its associated complications leads to the need to intensify its prevention and treatment. The treatment of obesity is currently based on lifestyle modification, which often fails in the long term. For the next decade, the long-term administration of anti-obesity drugs, i.e. drugs that have a positive effect not only on the reduction of excess weight but also on the health risks associated with obesity, seems to be a necessary part of obesity treatment, along with surgical approaches. This text provides an overview of the current options for the pharmacotherapy of obesity, including their indications, appropriate patient selection and adverse effects of treatment. It also provides an overview of studies that demonstrate the long-term efficacy and safety of these treatments. Although effective and safe anti-obesity drugs are currently available, it is not even partially covered by general health insurance. However, the cost of treatment is unaffordable in the long term for a large proportion of the obese. The virtual unavailability of effective antiobesity drugs for indicated patients has serious health-economic consequences. Failure to take advantage of effective therapeutic options, confirmed by evidence-based medicine, results in a high prevalence of obesity-related diseases, which are even more costly to treat economically and, in the case of type 2 diabetes, even less effective. We consider at least partial reimbursement of antiobesity drugs from general health insurance for cooperating patients under clearly defined conditions to be a necessary step towards improving the situation, and clearly cost-effective in its consequences.

Obesity and thyroid gland.

Decreased thyroid function (both overt and subclinical) is more frequent in overweight and obese people but hypothyroidism as cause of obesity is rare. Borderline or slightly elevated values of thyrotropin without other signs of autoimmune inflammation (elevated antibodies, changes at ultrasonography) are mostly consequence of hormonal/cytokine reactions to obesity, especially to hyperleptinemia. However, they simultaneously represent metabolic and cardiovascular risk factor.

Adult obese patient in primary care.

Overweight and obesity prevalence in middle aged subjects in the Czech Republic is more than 50 per cent, obesity is found in around 26 per cent of population. Obesity management is a long-term and time-consuming process. Early start of the treatment can prevent continuous weight gain and development of co-morbidities. General practitioners see obese patients usually as the first and they represent the first point of contact for adults with obesity. The basis of obesity management is a change of the lifestyle with added pharmacotherapy and/or bariatric/metabolic surgery. The paper presents overview of methods in obesity diagnostics and management and possibilities of their use in GPs daily practice.

[Status of pharmacotherapy in current care of obese]. / Postavení farmakoterapie v soucasné péci o obézní.

Weight loss drugs or anti-obesity drugs have a long history but are still far from being successful. Only in two last decades have the drugs been launched, which, when appropriately indicated, may be significantly beneficial to patients in need of weight loss as they are comparably effective to intensive programs to promote changes in eating habits and lifestyles. The combination naltrexone/bupropion is promising for food intake control including the reward mechanism, but the experience with its use has only been short-term. The lipase inhibitor orlistat remains the safest therapeutic option. The already restricted use of phentermine, newly classified as a controlled opiate substance, has become practically blocked. The range of weight loss drugs can be extended with some antidiabetics, particularly liraglutide and gliflozins. A number of other substances is still in the research stage.

[Perspective of obesity pharmacotherapy]. / Perspektivy farmakoterapie obezity.

Obesity is a very common disease with very difficult treatment. Most patients are not able to change their behaviour. Most hopeful for the future is a safe pharmacotherapy which could be widely used. In this review, old and potentially new drugs decreasing weight are mentioned (centrally acting anorectics, orlistat, incretine analogues and gliphlozines). Review of newly in U.S.A used antiobesitics is also mentioned. Finally potentially new principles of obesity pharmacotherapy are enumerated.

[Smoking and obesity]. / Kourení a obezita.

Smoking and obesity represent the current leading preventable health risks. Smoking and obesity increase the risk of many types of cancer, both smoking and abdominal obesity are insulinoresistant states, leading to endothelial dysfunction and high cardiovascular morbidity and mortality. Combining obesity with current smoking increases the risk of premature death more than 10-fold; the risk for obesity increases with number of cigarettes per day. Maternal smoking and smoking in families represent higher risk for children overweight/obesity. Weight gain after smoking cessation may be moderate, mostly is temporary and may be reduced by appropriate education and supporting therapies.

[A new concept of clinical classification of obesity]. / Návrh nové, klinické klasifikace obezity.

Current classification of obesity is based on the relative body weight and fat tissue distribution, it does not provide relevant information on functional status, quality of live and patient prognosis. A combination of obesity classes with 5 stages is being proposed, where the stages are defined by the presence of risk factors, obesity-related diseases and the level of functional impairment. Individual stages are associated with recommended preventive and treatment approaches.

Image texture analysis of sonograms in chronic inflammations of thyroid gland.

The current practice in assessing sonographic findings of chronic inflamed thyroid tissue is mainly qualitative, based just on a physician's experience. This study shows that inflamed and healthy tissues can be differentiated by automatic texture analysis of B-mode sonographic images. Feature selection is the most important part of this procedure. We employed two selection schemes for finding recognition-optimal features: one based on compactness and separability and the other based on classification error. The full feature set included Muzzolini's spatial features and Haralick's co-occurrence features. These features were selected on a set of 2430 sonograms of 81 subjects, and the classifier performance was evaluated on a test set of 540 sonograms of 18 independent subjects. A classification success rate of 100% was achieved with as few as one optimal feature among the 129 texture characteristics tested. Both selection schemes agreed on the best features. The results were confirmed on the independent test set. The stability of the results with respect to sonograph setting, thyroid gland segmentation and scanning direction was tested.

Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance.

OBJECTIVE: Adipose tIssue regulates insulin sensitivity via the circulating adipocytokines, leptin, resistin and adiponectin. The objective of this study was to compare the levels of resistin, adiponectin and leptin in lean and obese subjects and determine the relationship between circulating adipocytokines and insulin resistance. METHODS: We examined plasma levels of resistin, adiponectin and leptin in 17 lean subjects with a mean body mass index (BMI) of approximately 23 and 34 non-diabetic obese individuals with a mean BMI approximately 33. Insulin resistance was assessed using the homeostasis model assessment ratio (HOMA-R) formula derived from fasting insulin and glucose levels. RESULTS: Resistin levels were not significantly different between the two groups but were significantly higher in women compared with men, 35.4+/-6.5 (s.e.) vs 15.4+/-2.9 microg/L, P<0.01. Resistin did not correlate with BMI but did significantly correlate with HOMA-R, P<0.01, and this correlation remained significant after adjustment for gender and BMI. Adiponectin levels were significantly lower in obese compared with lean subjects, P<0.005, and higher in women, P<0.001, but showed no significant correlation with HOMA-R. Leptin levels were significantly higher in obese subjects and women and correlated with HOMA-R and resistin. DISCUSSION: In this small group of patients we demonstrated that insulin resistance correlated most strongly with leptin levels. A significant correlation between resistin levels and insulin resistance was also observed. Although a similar trend was apparent for adiponectin, the correlation with insulin resistance did not achieve statistical significance.

Relation between quantitative description of ultrasonographic image and clinical and laboratory findings in lymphocytic thyroiditis.

OBJECTIVE: Relations between measurable properties of B-mode ultrasound images of thyroid gland and clinical and laboratory findings in patients with chronic inflammation of thyroid gland were studied. METHODS: Data from 65 patients with lymphocytic thyroiditis (LT) and 38 control subjects were analysed. Raw values of individual B-mode image pixels and standard co-occurrence second-order texture features were selected as quantitative image features. Thyroid antibodies, thyrotropin level, thyroxine replacement therapy, and body mass index were used as clinical variables. RESULTS: In the LT group, significant differences (t-tests, p<0.05) in image features were found for body mass indices (BMI) under and over 25 kg.m(-2), for thyroxine replacement therapy, and for the presence and absence of thyroid antibodies. Forward stepwise multiple regression was performed for the clinical or laboratory values as dependent variables and image features as independent variables. The following correlations were found: 1. between BMI and four image features in the normal group; 2. between the dose of thyroxine replacement therapy and two of image features in the LT group; and 3. for the level of thyroid antibodies in the LT group: five image features have correlated with the level of anti-thyroglobulin and three image features with level of anti-thyroperoxidase. CONCLUSION: These findings suggest the possibility of using quantitative indicators of ultrasound image of thyroid gland as predictors of the presence or absence of thyroid antibodies in patient's blood or as an auxiliary tool for dose recommendation of thyroxine replacement therapy.

Quantitative indicators of sonographic image of thyroid gland and their relation to antithyroid antibodies in Hashimoto's lymphocytic thyroiditis.

Sonography is a widely used non-invasive diagnostic tool and its main advantage is low cost in comparison with other diagnostic methods such as immunological analyses. In this work it is presented the relation between a sonographic image of thyroid gland and an immunological status of the patients with Hashimoto's lymphocytic thyroiditis (chronic inflammation of the thyroid gland). The results, evaluated on a set of 740 B-mode sonographic images from 37 subjects, show that raw values of individual image pixels in sonogram of thyroid gland with presence and without presence of anti-thyroid antibodies are significantly different (means 31.87 and 44.56; standard deviations 8.6 and 11.82; t = 3.4; p = 0.0017) and that they can be used for the prediction of presence of anti-thyreoglobulin and anti-thyreoperoxidasis antibodies. This result suggests the possibility to use this method in clinical diagnostic process for reducing the costs. Also the correlation between the image features and the level of antibodies was examined. The highest correlation was found for inverse difference moment and the level of anti-thyreoperoxidasis (coefficient of determination 0.43).