Managing Cardiometabolic Risk

Conclusions

As reviewed above, the studies on pharmacological treatment of obesity indicate that some drugs do promote body weight loss, possibly (and not surprisingly) even more so when used as a complement to lifestyle management. However, it is important to note that most studies have so far focused on weight loss alone and were conducted largely in women with relatively few metabolic abnormalities and at low risk of CVD. Given the well-established link between intra-abdominal obesity and CVD and type 2 diabetes risk, there is a definite need for more studies (RIO-Lipids being one example) that target at-risk individuals, men in particular.

Because of deeply entrenched prejudice regarding causality, physicians are understandably reluctant to treat obesity pharmacologically. But objective clinical reality and the environment in which many of us now live strongly suggest that willpower alone is not a viable solution and point to pharmacotherapy as a necessary complement to dietary and physical activity interventions.

Although the number of available tools remains limited, basic and clinical research has identified control systems that show great promise as targets for the successful treatment of at-risk obesity. Because of their additive effect on independent pathways, the systems that jointly improve central control of food intake and peripheral metabolic pathways associated with intra-abdominal adipose tissue metabolism are of particular interest. The endocannabinoid CB1 pathway is an example of such a system (Figures 5 and 6), and others are currently under intensive study.