As the morbidity and mortality of obesity have significantly increased, most current guidelines recommend pharmacotherapy as the second line of treatment
for this disorder following lifestyle modifications. Pharmacological treatment should be considered as part of
a comprehensive strategy for the treatment of patients
with a BMI ≥30 or ≥27 kg/m2
and an obesity-related comorbidity—HTN, T2DM, dyslipidemia, and sleep apnea.
Additionally, the efficacy of medical treatment should
be evaluated after the first 3 months of drug use. Substantial research has been dedicated to the development
of a newer generation of anti-obesity drugs. In recent
years, many novel agents have undergone phase III
clinical trials. Compared to placebo, these drugs cause
Young Jin Tak and Sang Yeoup Lee: An Updated Review on Anti-Obesity Drugs
www.wjmh.org 217
Table 2. Data from meta-analyses of the anti-obesity drugs approved for long-term use for weight loss
Drug
Study
(duration
≥1 year)
Subject
(drug/placebo)
Lifestyle intervention
(diet/exercise/behavior)
Weighted mean difference
(kg) (95% CI) for the
drug-to-placebo
comparison at 1 year
% weight loss
(drug/placebo)
Odds ratio
(95% CrI) for
achieving
≥5% weight
loss
% of patients with
≥5% weight
loss at 1 year
(drug/placebo)
% of patients with
≥10% weight
loss at 1 year
(drug/placebo)
Odds ratio
(95% CrI) for
discontinuation
due to adverse
event
Orlistat 17 trials 5,572/5,572 Reduced fat intake or
500–800 kcal deficit/
non-specific increase or
30 minutes of moderate
exercise per day/yes or
no
2.60
(2.16–3.04)
4.6/1.7 2.70
(2.34–3.09)
48.8/22.6 17.9/8.8 1.84
(1.53–2.21)
Phentermine/
topiramate
3 trials 1,802/1,735 500 kcal deficit/nonspecific increase/yes 8.80 (7.42–10.2) 8.5/1.7 9.22 (6.63–12.85) 72.0/22.8 49.7/8.6 2.29 (1.71–3.06)
Naltrexone/
bupropion
5 trials 6,963/5,897 500 kcal deficit/nonspecific increase or
30 minutes of moderate
exercise per day/yes
4.95
(3.96–5.94)
6.1/2.1 3.96
(3.03–5.11)
52.4/28.3 28.3/9.7 2.64
(2.10–3.35)
Liraglutide 4 trials 3,096/1,649 500 kcal deficit/minimum
150 minutes of brisk
walking per week/yes
5.27
(4.52–6.06)
7.1/1.7 5.54
(4.16–7.78)
60.3/24.6 30.4/8.4 2.95
(2.11–4.23)
Lorcaserina 4 trials 9,453/9,440 600 kcal deficit/30
minutes of moderate
exercise per day/yes
3.22
(2.46–3.97)
5.1/2.0 3.10
(2.38–4.05)
42.7/19.7 19.0/6.7 1.34
(1.05–1.76)
CI: confidence interval, CrI: credible interval.
aWithdrawn from the market for safety issue related to an increased cancer incidence in February 2020.
https://doi.org/10.5534/wjmh.200010
218 www.wjmh.org
a significant weight reduction, including meaningful
improvements in cardiometabolic profiles, while demonstrating good tolerability and safety in patients with
obesity. Data from most recent meta-analyses showed
that the overall placebo-subtracted weight reduction (%)
with the use of anti-obesity drugs for at least 12 months
ranges from 2.9% to 6.8%; phentermine/topiramate (3
trials, -6.8%) liraglutide (4 trials, -5.4%), naltrexone/bupropion (5 trials; -4.0%), lorcaserin (4 trials; -3.1%), and
orlistat (17 trials, -2.9%) (Table 2) [56,84-88].
Most prior trials conducted on these medications
also performed an intensive consultation on diet and
exercise in not only the placebo but also the treatment
groups. Thus, these medications were proposed for
use as pharmacotherapy in conjunction with healthy
eating, physical activity, and behavior modification.
Further, prior findings demonstrated that anti-obesity
drugs cannot be used as a panacea for the treatment
of obesity; instead, they should be used to facilitate
weight control.
Conflict of Interest
The authors have nothing to disclose.
Author Contribution
Conceptualization: SYL. Investigation: SYL, YJT. Writing –
original draft: YJT. Writing – review & editing: SYL, YJT.
REFERENCES
1. World Health Organization. Obesity and overweight. Fact
sheet [Internet]. Geneva: World Health Organization; c2018
[cited 2020 Jan 12]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.
2. Chen Y, Peng Q, Yang Y, Zheng S, Wang Y, Lu W. The prevalence and increasing trends of overweight, general obesity,
and abdominal obesity among Chinese adults: a repeated
cross-sectional study. BMC Public Health 2019;19:1293.
3. Park YW, Choi KB, Kim SK, Lee DG, Lee JH. Obesity in
Korean men: results from the fourth through sixth Korean National Health and Nutrition Examination Surveys
(2007~2014). World J Mens Health 2016;34:129-36.
4. Palmer BF, Clegg DJ. The sexual dimorphism of obesity. Mol
Cell Endocrinol 2015;402:113‐9.
5. Hwang JH, Ryu DH, Park SW. Interaction effect between
weight perception and comorbidities on weight control behavior in overweight and obese adults: Is there a sex difference? J Korean Med Sci 2015;30:1017-24.
6. White UA, Tchoukalova YD. Sex dimorphism and depot differences in adipose tissue function. Biochim Biophys Acta
2014;1842:377‐92.
7. Fui MN, Dupuis P, Grossmann M. Lowered testosterone
in male obesity: mechanisms, morbidity and management.
Asian J Androl 2014;16:223-31.
8. Masterson JM, Soodana-Prakash N, Patel AS, Kargi AY,
Ramasamy R. Elevated body mass index is associated with
secondary hypogonadism among men presenting to a tertiary
academic medical center. World J Mens Health 2019;37:93-8.
9. Moon KH, Park SY, Kim YW. Obesity and erectile dysfunction: from bench to clinical implication. World J Mens Health
2019;37:138-47.
10. Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults--the evidence
report. National Institutes of Health. Obes Res 1998;6 Suppl
2:51S-209S.
11. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity
in Korean adults. Diabetes Res Clin Pract 2007;75:72-80.
12. Curioni CC, Lourenço PM. Long-term weight loss after
diet and exercise: a systematic review. Int J Obes (Lond)
2005;29:1168-74.
13. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG,
Donato KA, et al. 2013 AHA/ACC/TOS guideline for the
management of overweight and obesity in adults: a report
of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity
Society. Circulation 2014;129:S102-38.
14. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley
DL, Jastreboff AM, et al. American Association of Clinical
Endocrinologists and American College of Endocrinology
comprehensive clinical practice guidelines for medical care of
patients with obesity. Endocr Pract 2016;22 Suppl 3:1-203.
15. Bhat SP, Sharma A. Current drug targets in obesity pharmacotherapy - a review. Curr Drug Targets 2017;18:983-93.
16. Coulter AA, Rebello CJ, Greenway FL. Centrally acting agents
for obesity: past, present, and future. Drugs 2018;78:1113-32.
17. Daneschvar HL, Aronson MD, Smetana GW. FDA-approved anti-obesity drugs in the United States. Am J Med
2016;129:879.e1-6.
18. Apovian CM, Ar
