Long-term randomized clinical trials of pharmacological treatment of\nobesity: Systematic review*

Introduction: Obesity has become a public health problem. The increment\nin energy intake and the reduction of caloric expenditure as a result\nof sedentary lifestyles promotes a positive energetic balance resulting\nin the increase of fat deposits. In response to this, the prescription\nof pharmacological treatments has also increased. Objective: To\nevaluate the long-term weight loss effectiveness of pharmacological\ntreatments. Methodology: A systematic review was conducted on\nrandomized clinical trials registered in Pub Med, Scielo, and EBSCOHOST\nfrom January 1st 1999 to December 31st 2008, including those with an\nintervention program with orlistat, sibutramine, and rimonabant equal\nor greater to two years. Two hundred and twelve articles were\nidentified, 201 studies were excluded, and eleven were analyzed; seven\nfrom orlistat, two from sibutramine, and two from rimonabant.\nInformation of design, intervention time, number of patients, age, body\nmass index and weight loss, difference between the intervention group\nversus the placebo, significance level, and methodological quality were\nobtained. Main findings: The percentage of weight loss with orlistat\nranged between 5 and 12%, the mean weight loss was 8 kg, and a\ndifference between IG vs. placebo of 3.7 kg. Weight loss with\nsibutramine ranged between 4 and 10%, the mean weight loss was 7.4 kg\nand a difference between the intervention group versus placebo was 5.5\nkg. Weight loss with rimonabant was 7% with a mean weight loss of 7.3\nkg, and the difference compared with the placebo was 4.4 kg.\nConclusions: Weight loss with pharmacotherapy is modest; weight regain\nafter interruption of treatment, adverse effects, costs and lack of\nevidence related to long-term morbi-mortality, do not justify the\ngeneralized use of pharmacological treatment of obesity.