Introduction
Obesity is a multifactorial condition associated with an increased risk of chronic diseases, including type 2 diabetes, arterial hypertension and cardiovascular dysfunction. Although sustained interventions in lifestyle changes are the mainstay of treatment, pharmacotherapy represents a relevant complementary option, especially for individuals who do not achieve success with effective methods. This study critically reviews the efficacy and safety of the main pharmacological approaches available in Brazil for the management of obesity.
Methods
A narrative review of the literature was performed using strict inclusion and exclusion criteria. Articles were selected from PubMed, SciELO, and the Cochrane Library databases, addressing pharmacological strategies for the treatment of obesity in adult patients. The drugs analyzed include orlistat, sibutramine, GLP-1 receptor agonists (liraglutide and semaglutide), a combination of bupropion and naltrexone, and lisdexamfetamine. Their efficacies, mechanisms of action, safety profiles, and metabolic impacts were evaluated.
Results
Orlistat: acts as an inhibitor of gastrointestinal lipases, reducing fat absorption. Studies indicate effectiveness in weight loss when combined with a low-calorie diet. The main adverse effects include gastrointestinal discomfort and steatorrhea.
Sibutramine: serotonin and norepinephrine reuptake inhibitor, promotes satiety and reduces calorie intake. Although effective, its use is contraindicated in patients with cardiovascular risk due to increased blood pressure and heart rate.
GLP-1 receptor agonists: liraglutide (daily use) and semaglutide (weekly use) have demonstrated significant weight loss and improvement in metabolic interactions. Semaglutide was superior to liraglutide in weight loss and treatment adherence. Nausea and vomiting were the most common adverse effects.
Bupropion + Naltrexone: modulates appetite control centers in the central nervous system. Studies indicate efficacy in weight reduction, especially when associated with behavioral interventions. Adverse effects include nausea, headache, and insomnia.
Lisdexamfetamine: approved for the treatment of Binge Eating Disorder (BED), demonstrated efficacy in reducing binge eating episodes and weight loss. However, it requires monitoring due to adverse effects such as insomnia, xerostomia and increased heart rate.
Discussion
The choice of pharmacological treatment should consider the individual clinical profile, with emphasis on therapeutic personalization to optimize stages. Planned clinical trials indicate that semaglutide is the most effective option for sustained weight loss, while orlistat remains relevant for patients who prefer an approach without effects on the central nervous system. Lisdexamfetamine has specific benefits for BED, but with the need for continuous monitoring.
Conclusion
Pharmacological treatment of obesity is a powerful tool, but it must be integrated with lifestyle changes to maximize efficacy and reduce risks. Individualization of treatment, based on the patient’s metabolic and clinical characteristics, is essential to obtain better results. Future studies should investigate the long-term safety of these interventions, especially in patients with associated comorbidities.
Keywords: obesity, pharmacotherapy, GLP-1 receptor agonists, sibutramine, bupropion, lisdexamfetamine.
Reference:
SILVA, Caio Marques da et al. Journal of Medical Research and Biosciences , v. 1, n. 510.70164 /jmbr .v1i5.423 .
