ImportanceObesity affects approximately 19% of women and 14% of men worldwide and is associated with increased morbidity. Antiobesity medications (AOMs) modify biological processes that affect appetite and significantly improve outcomes, such as type 2 diabetes, hypertension, and dyslipidemia.ObservationsAOMs should be administered in combination with lifestyle interventions and can be classified according to their mechanisms of action. Orlistat modifies digestive tract absorption and causes gastrointestinal adverse effects, such as oily fecal spotting and urgency, in more than 25% of patients. Centrally acting drugs, such as phentermine-topiramate and naltrexone-bupropion, regulate appetite in the brain and are associated with constipation in approximately 20% of patients, although the incidence of other adverse effects (eg, paresthesia, nausea) varies by medication. Nutrient-stimulated hormone-based medications, such as liraglutide, semaglutide, and tirzepatide, mimic the actions of enteropancreatic hormones that modify central appetite regulation and provide multiple cardiometabolic weight-loss benefits. Adverse effects of these drugs include nausea (28%-44%), diarrhea (21%-30%), and constipation (11%-24%). The relative potency of adult obesity medications has been studied in meta-analyses. Compared with placebo, orlistat was associated with 3.1% greater weight loss (52 randomized clinical trials [RCTs]; 16 964 participants), phentermine-topiramate was associated with 8.0% greater weight loss (5 RCTs; 3407 participants), naltrexone-bupropion was associated with 4.1% greater weight loss (6 RCTs; 9949 participants), liraglutide was associated with 4.7% greater weight loss (18 RCTs; 6321 participants), semaglutide was associated with 11.4% greater weight loss (5 RCTs; 4421 participants), and tirzepatide 15 mg was associated with 12.4% greater weight loss (6 RCTs; 1972 participants).Conclusion and RelevanceObesity is associated with increased morbidity. Antiobesity medications are effective adjunctive therapy to lifestyle changes for improved weight loss and health outcomes.

中文翻译：

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 治疗肥胖的药物


重要性肥胖影响着全世界大约 19% 的女性和 14% 的男性，并且与发病率增加有关。抗肥胖药物 (AOM) 可以改变影响食欲的生物过程并显着改善治疗结果，例如 2 型糖尿病、高血压和血脂异常。观察结果 AOM 应与生活方式干预措施结合使用，并可根据其作用机制进行分类。奥利司他会改变消化道吸收，并导致 25% 以上的患者出现胃肠道不良反应，例如油性便便和尿急。芬特明托吡酯和纳曲酮安非他酮等中枢作用药物可调节大脑食欲，并与约 20% 患者的便秘有关，尽管其他不良反应（例如感觉异常、恶心）的发生率因药物而异。营养刺激激素类药物，如利拉鲁肽、司马鲁肽和替泽帕肽，模仿肠胰激素的作用，改变中枢食欲调节，并提供多种心脏代谢减肥益处。这些药物的不良反应包括恶心（28%-44%）、腹泻（21%-30%）和便秘（11%-24%）。荟萃分析研究了成人肥胖药物的相对效力。与安慰剂相比，奥利司他与体重减轻增加 3.1%（52 项随机临床试验 [RCT]；16 964 名受试者），芬特明-托吡酯与体重减轻增加 8.0%（5 项随机对照试验；3407 名受试者），纳曲酮-安非他酮与体重减轻有关。与体重减轻幅度增加 4.1% 相关（6 项随机对照试验；9949 名受试者），利拉鲁肽与体重减轻幅度增加 4.7% 相关（18 项随机对照试验；6321 名受试者），索马鲁肽与 11 项相关。体重减轻幅度增加 4%（5 项随机对照试验；4421 名受试者），替西帕肽 15 mg 与体重减轻幅度增加 12.4% 相关（6 项随机对照试验；1972 名受试者）。结论和相关性肥胖与发病率增加相关。抗肥胖药物是改变生活方式的有效辅助疗法，可改善体重减轻和健康结果。