Obesity is a global public health problem. Obesity, as a chronic disease, increases the risk of multiple metabolic diseases, leading to a variety of health problems, including type 2 diabetes, cardiovascular disease, depression, and malignancy. According to data from an article published in The Lancet Diabetes and Endocrinology in May 2021, the prevalence of overweight and obesity in adults aged 18 and over in China exceeded 50% for the first time. This means that at least one in two adults is overweight or obese.
There are three treatments for obesity, namely lifestyle intervention, drug intervention and surgical treatment. Among them, lifestyle intervention is the first choice and is the most important and basic treatment method, while drug intervention and surgical treatment have strict indications.
A recent systematic review and network meta-analysis of drug treatment for overweight and obesity in adults, published in The Lancet, evaluated the safety and efficacy of drugs used in overweight and obese adults.
The meta-study included 143 independent randomised controlled trials (RCTs) with 49,810 adult participants. Among participants, median age was 47 (IQR 43-54) years, median female proportion was 75% (54-89), median baseline BMI was 35.3 (33.1-36.8) kg/m2, median follow-up time 24 (24~52) weeks. With the exception of L-carnitine, all drug weight-reduction results were compared with lifestyle intervention alone.
High to moderate certainty evidence that phentermine-topiramate is the most effective weight loss drug (weight loss ≥5%, OR: 8.02, 95% CI: 5.24 to 12.27; mean difference MD for percent weight change: -7.97, 95% CI, -9.28 to -6.66), followed by GLP-1 receptor agonists (OR 6.33, 95% CI 5.00 to 8.00; MD, -5.76, 95% CI -6.30 to -5.21). Naltrexone/bupropion (OR 2.69, 95% CI 2.11-3.43), phentermine-topiramate (OR 2.40, 95% CI 1.69-3.42, GLP-1 receptor agonist (OR 2.17, 95% CI) 1.71-2.77) and orlistat (OR 1.72, 95% CI 1.44-2.05) were associated with discontinuation due to an increased risk of adverse events. In a causal analysis, the GLP-1 receptor agonist semaglutide was similar to other showed a significantly greater benefit compared with drugs in the risk of adverse events, both in the likelihood of weight loss of 5% or more (OR: 9.82, 95%CI: 7.09-13.61) and in percent weight change (MD: ?11 41 , 95% CI -12·54~-10·27).
For overweight and obese adults, phentermine-topiramate and GLP-1 receptor agonists have been shown to be the best weight loss drugs; of the GLP-1 agonists, semaglutide may be the most effective.
