Study summary · research use only
Pharmacological management of appetite expression in obesity
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This review discusses pharmacological management of appetite expression in obesity (human context). The authors argue that traditional drug development neglects psychological factors influencing appetite, focusing instead on intake and weight reduction criteria and a mechanistic view of energy regulation. They describe drugs under development that may change appetite expression in the obese, including glucagon-like peptide-1 analogs such as liraglutide, an amylin analog davalintide, the 5-HT2C receptor agonist lorcaserin, the monoamine reuptake inhibitor tesofensine, and combination therapies such as pramlintide and metreleptin, bupropion and naltrexone, phentermine and topiramate, and bupropion and zonisamide. They note that effects on eating behavior remain poorly characterized, and argue that behavioral analysis can identify drugs that selectively affect desire to eat, enjoyment of eating, satiation, or postmeal satiety, suggesting these processes as targets for pharmacotherapy.
Abstract
For obese individuals, successful weight loss and maintenance are notoriously difficult. Traditional drug development fails to exploit knowledge of the psychological factors that crucially influence appetite, concentrating instead on restrictive criteria of intake and weight reduction, allied to a mechanistic view of energy regulation. Drugs are under development that may produce beneficial changes in appetite expression in the obese. These currently include glucagon-like peptide-1 analogs such as liraglutide, an amylin analog davalintide, the 5-HT(2C) receptor agonist lorcaserin, the monoamine re-uptake inhibitor tesofensine, and a number of combination therapies such as pramlintide and metreleptin, bupropion and naltrexone, phentermine and topiramate, and bupropion and zonisamide. However, the effects of these treatments on eating behavior remain poorly characterized. Obesity is typically a consequence of overconsumption driven by an individual's natural sensitivity to food stimuli and the pleasure derived from eating. Intuitively, these processes should be effective targets for pharmacotherapy, and behavioral analysis can identify drugs that selectively affect desire to eat, enjoyment of eating, satiation or postmeal satiety. Rational interventions designed specifically to modulate these processes could limit the normally aversive consequences of caloric restriction and maximize an individual's capacity to successfully gain control over their appetite.
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