Pharmacological treatment of obesity

A number of compounds act either to suppress the activity of the hunger centre in the hypothalamus or to stimulate the satiety centre. Sometimes this is an undesirable side-effect of drugs used to treat disease and can contribute to the undernutrition seen in chronically ill people (section 8.4). As an aid to weight reduction, especially in people who find it difficult to control their food intake, drugs that suppress appetite can be useful. Three compounds are in relatively widespread use as appetite suppressants: fenfluramine (and more recently the d-isomer, dexfenfluramine), diethylpropion and mazindol. The combination of phentermine and fenfluramine was withdrawn in the 1990s, after a number of reports associating it with cardiac damage, and there is some evidence of psychiatric disturbance and possible problems of addiction with these drugs. They should be used for only a limited time, and only under strict medical supervision. The action of appetite suppressants decreases after a few weeks, as tolerance or resistance to their action develops.

A number of compounds have been marketed as 'carbohydrate blockers', which are supposed to act by inhibiting amylase (section, and so reducing the digestion of starch. There is no evidence that they are effective, and none has been licensed for pharmaceutical use.

Inhibitors of pancreatic lipase (section 4.3.2) do reduce lipid digestion and absorption, and some have been licensed for pharmaceutical use. The problem with their use is that undigested fat in the gastrointestinal tract can cause discomfort and, if enough is present, foul-smelling fatty diarrhoea (steatorrhoea).

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