23 weight loss drugs approved clinical, Shi Yao, Gan Li, Le Pu...

No weight loss in April, May, June, July, August, September...

Obesity ruins not only our appearance, but also our mentality and health.

01
The epidemiology of obesity

Obesity refers to excessive total body fat content and/or increased local content and abnormal distribution. It is a chronic metabolic disease caused by the interaction of genetic and environmental factors. Obesity mainly includes three characteristics: increased number of adipocytes, imbalance of body fat distribution and local fat deposition [1].

In the past 30 years, the prevalence of obesity has increased significantly, which has become a major global public health crisis. The current obesity situation in China is serious. Data from the "China Nutrition and Chronic Diseases Report (2020)" showed that more than half of Chinese adults were overweight or obese, with overweight and obesity rates of 34.3% and 16.4%, respectively. Among children under 6 years of age, 1 in 10 is overweight or obese, with rates of overweight and obesity of 6.8% and 3.6%, respectively. Nearly one in five adolescents aged 6-17 years was overweight or obese, with prevalence rates of overweight and obesity as 11.1% and 7.9%, respectively.

In recent years, the prevalence of overweight and obesity in rural areas has increased faster than that in urban areas, and the gap between urban and rural areas is gradually narrowing. In China, the prevalence of overweight and obesity was higher in people with better socioeconomic status. Among men, higher education level was associated with higher prevalence of overweight and obesity, but the opposite was observed among women.

02
The only weight-loss drug approved in China

Drug therapy is one of the important methods for the treatment of obesity, but its use tends to be conservative in China, and the choice of weight loss drugs is also limited, so drug therapy is not as common in China as in the United States and Europe.

At present, the drugs approved by the US FDA for the treatment of obesity mainly include cyproxymorphone (naltrexone)/bupropion, lorcaserin, phentermine/topiramate, orlistat, and liraglutide. Orlistat [1] is the only drug that has indications for the treatment of obesity and has been approved by the State Food and Drug Administration in China, and the dosage forms are tablets and capsules. Liraglutide and semaglutide have not been approved as indications for obesity in China.

Orpristal was developed by Roche and was first approved by the European Medicines Agency (EMA) on July 29, 1998, and then by the United States Food and Drug Administration (FDA) on April 23, 1999. It is marketed by Roche in Europe and the United States under the brand name Xenical. Xenical is available as oral capsules, each containing 120mg orlistat. The recommended dose is 120mg three times daily with a fat-containing main meal (during or within 1 hour after the meal).

Orlistat is a gastrointestinal lipase inhibitor, which can reduce body fat content by blocking the body's absorption of fat from food and achieve the purpose of weight loss. It is used for weight control in combination with a mild hypocaloric diet in obese patients with a body mass index (BMI) of 30kg/m2 or greater or in overweight patients with a BMI of 28kg/m2 and associated risk factors. Orlistat decreases the absorption of fat-soluble vitamins and β-carotene, so patients should take a multivitamin that includes fat-soluble vitamins while taking orlistat. Rare adverse reactions included transaminase elevation, severe hepatitis, anaphylaxis, etc.

03
Analysis of the research status of diet drugs in China

At present, orlistat is the only weight-loss drug approved for marketing, but there are 23 weight-loss drugs approved for clinical use, including 11 biological products, 10 chemical drugs and 2 traditional Chinese medicine.

Biological products include semaglutide injection and liraglutide injection, etc. Semaglutide injection and liraglutide injection have completed phase Ⅲ clinical trials in the intervention of adult obesity or overweight, and it is believed that the market date for the prevention of obesity will be soon.

04
Summary of traditional Chinese medicine weight loss products

Traditional Chinese medicine has a long history of being used for weight loss, such as Fangfeng Tongsheng SAN in Xuanming Lun, Fangji Huangqi decoction and Zexie decoction in Yaolue of the Golden Chamber, etc. At present, there are 19 products of traditional Chinese medicine on the market, including tea, tablets, capsules, granules, etc.