Overview of Drug-Based Weight Loss and Appetite Suppressants (Part 1)
Weight loss through medication and surgery
I. Weight Loss Through Drugs
Drug treatment for obesity does not play a significant role because the mechanism of obesity is not yet fully understood, so we have not yet found a truly effective drug for treating obesity.
The drug-based weight loss discussed in this chapter refers to weight loss treatment using Western medicine.
Some doctors advocate against giving patients any medication, arguing that medication for obesity will lead patients to have unrealistic expectations, placing their hopes on the drugs instead of focusing on dietary management, changing their eating habits, and giving up exercise.
However, based on current research findings, a significant portion of people who participate in diet and exercise for weight loss experience ineffective results or, even if they initially see results, experience a rebound in weight gain.
Therefore, we believe that necessary drug treatment can be used as an adjunct to diet and exercise therapy to encourage patients to adhere to long-term treatment, and drug-based weight loss methods can be tried for some patients with refractory obesity.
Readers should note that weight loss medications should be taken under the guidance of a doctor.
This book provides a brief introduction to weight loss medication in order to give readers a comprehensive understanding of weight loss methods, but readers should not take medication on their own.
The indications for drug-based weight loss are: those who cannot adhere to or tolerate dietary control; those who have failed to control their diet; those who have controlled their diet for 6 months or 1 year, whose weight has dropped to normal, but whose symptoms have recurred and whose weight has exceeded the standard again; and severely obese patients.
Currently, there are many types of weight loss drugs, which can be roughly divided into appetite suppressants, hormone drugs that accelerate metabolism, drugs that affect digestion and absorption, and drugs that mobilize local fat breakdown.
Among the many medications available, appetite suppressants are the most effective and widely used.
Among them, amphetamine drugs are widely used. Fluamphenicol is one of the most commonly used and reported drugs for treating obesity in recent years. It has a certain therapeutic effect on obesity and has relatively few side effects.
The specific usage methods of weight-loss drugs are described below.
(a) Appetite suppressants
Appetite suppressants are drugs that reduce weight by suppressing appetite and decreasing energy intake.
Also known as anti-obesity drugs or slimming agents.
Most of them work through the central neurotransmitters catecholamines and serotonin, which regulate the feeding and satiety centers, thus causing weight loss.
Appetite suppressants include drugs such as catecholamine neurotransmitters and serotonin neurotransmitters.
1. Catecholamine neurotransmitter drugs: This category includes amphetamines and their derivatives, as well as indoles and their derivatives.
(1) Amphetamines are a type of central nervous system stimulant. In 1930, scholars discovered that amphetamine could suppress appetite. Its derivatives include toluenepropamine, benzylpropamine, benzylmorpholine, benzylbismorpholine, chlorophenbutamine, o-chlorophenamine and diethylamine benzophenone, etc.
Pharmacological effects: ① Promotes the release of dopamine and norepinephrine, while blocking the reuptake of catecholamines by nerve endings; ② Stimulates the central nervous system, promotes metabolism and increases thermogenesis, and increases the uptake and utilization of glucose by muscle and adipose tissue; ③ Affects fat metabolism.
Amphetamine, toluene, and benzyl morpholine can promote fat breakdown, increasing the concentration of free fatty acids and/or triglycerides in plasma. Chlorpheniramine has a significant effect in reducing total blood lipids and cholesterol.
The main side effects include: ① stimulation of the central nervous system, including nervousness, agitation, temporary insomnia, reduced fatigue, increased mental pleasure, and easy addiction.
If the dosage is too high, it can cause mental stress, slow movements, and stereotyped, repetitive actions.
② Symptoms of sympathetic nerve excitation include dry mouth, blurred vision, mild headache and dizziness, tachycardia, high blood pressure, and sweating.
Some patients may experience mild hand tremors.
③ Gastrointestinal irritation symptoms: such as nausea, vomiting, and constipation.
④ If the dosage is too high, some patients may experience psychotic symptoms, such as hallucinations and delusions.
It closely resembles schizophrenia.
⑤ Some patients may experience drug allergies.
Contraindications: ① Glaucoma: These drugs have a mydriatic effect and can lead to increased intraocular pressure; ② Hyperthyroidism: Can worsen patients' excitatory symptoms; ③ Can worsen psychomotor agitation, hallucinations, and delusions in patients with mania or schizophrenia; ④ Sympathetic amine allergy; ⑤ Avoid concurrent use with monoamine ester inhibitors, as this can cause hypertensive crisis; ⑥ Pregnant women and those in hazardous occupations, such as drivers; ⑦ Poor liver and kidney function, hypertension, and heart disease.
Among these drugs, amphetamine has the most severe side effects, and its use as an appetite suppressant has been banned in other countries.
The most commonly used in clinical practice are diethylamine benzophenone and phenylbutylamine resin.
(2) Indole drugs chlorpheniramine and cycloimidazol are indole derivatives and have catecholamine neurotransmitter effects.
Chlorpheniramine indole can excite adrenergic neurons in the brain and directly inhibit the feeding center in the hypothalamus. It can also promote the utilization of glucose by tissues such as muscle and fat and reduce serum cholesterol and triglycerides.
It has fewer side effects than amphetamines and has no effect on blood pressure or heart rate.