The value of drugs for obesity in the management of cardiovascular risk factors

Obesity is a chronic disease corresponding to an excess of fatty mass. Its definition is based on the calculation of the Body Mass Index (BMI = weight (Kg)/height(m)(2)). The association of overweight and obesity is observed in nearly half of the French population. There are only two molecules available for treating overweight: orlistat, a pancreatic and intestinal lipase inhibitor, reducing the absorption of fat, and sibutramine, a selective inhibitor of serotonin, noradrenaline and dopamine recapture. They are prescribe for BMI 30 Kg/m(2) or overweight (BMI 28 Kg/m(2) for orlistat and 27 Kg/m(2) for sibutramine) associated with cardiovascular risk factors. Clinical trials show that the expected weight loss is 3 to 4 Kg compared with placebo. In addition, orlistat should improve blood sugar and lipid levels and reduce blood pressure. Sibutramine increases HDL cholesterol, decreases triglycerides but increases the blood pressure and heart rate. A trial is underway to study the impact of these adverse effects in subjects at high cardiovascular risk. Therefore, the field for the development of new drugs for treating overweight and obesity remains wide open.