Lifestyle intervention and pharmacological approaches to weight loss
The global epidemic of obesity and its associated complications has hastened the need with which we must understand both the patho-physiological process that contribute to its development, and also the urgency with which we need therapeutic solutions that offer clinically meaningful and sustained weight loss. There is clear evidence as to the beneficial impact of exercise upon health, in particular cardiovascular health, in normal weight and obese individuals as well as those with type 2 diabetes. Exercise training is associated with decreased cardiovascular risk, less atherogenic lipid profiles, improvements in blood pressure and insulin sensitivity. Importantly, the decline in insulin sensitivity once exercise training is discontinued exemplifies the need for permanent lifestyle modification and regular exercise. Pharmacological approaches have become more limited in recent years with the demise of several anti-obesity medications, most recently Sibutramine, due to increased non-fatal cardiovascular and cerebrovascular events. Orlistat is now the only available licensed anti-obesity therapy in the UK. However, new therapies are emerging fast, including the use of GLP-1 analogues, which in the context of the treatment of patients with type 2 diabetes are an exciting advance. The field of anti-obesity medication is full of exciting prospects, yet the challenge remains to find efficacious, safe and well tolerated drugs that will serve as an important component of the holistic approach to weight management.