Book Review

Pharmacotherapy of Obesity: Options and Alternatives

N Engl J Med 2005; 352:2462-2463June 9, 2005

Article

Pharmacotherapy of Obesity: Options and Alternatives
Edited by Karl G. Hofbauer, Ulrich Keller, and Olivier Boss. 488 pp., illustrated. Boca Raton, Fla., CRC Press, 2004. $149.95. ISBN: 0-415-30321-4

With the global epidemic of obesity and its coexisting conditions, the need for effective obesity treatments has never been greater. Current behavioral and dietary therapies frequently lead to sufficient weight loss to reduce risk factors such as hypertension and dyslipidemia. However, with the exception of bariatric surgery, treatments resulting in long-term maintenance of lost weight remain elusive. At the same time, advances in basic science have led to a better understanding of the pathways that affect energy balance and to the identification of myriad potential central and peripheral drug targets. Hence, a comprehensive textbook focusing on the pharmacotherapy of obesity is timely.

The target audience of Pharmacotherapy of Obesity is physicians and other health care professionals who treat obesity. The book's six sections cover the pathophysiology of obesity, general therapeutic aspects, benefits of weight loss, drugs on the market, drugs in research and development, and treatment alternatives (which include herbal supplements and bariatric surgery). The quality of the chapters and the level of detail vary considerably. The chapter titled “Diet, Physical Activity, and Behavior” is written for the nonspecialist and provides practical advice on behavioral strategies, whereas the chapter titled “The Pathophysiology of Appetite Control” is more appropriate for a graduate student or researcher. A chapter (or at least more information) on the use of medications to treat obesity in children and adolescents would have been helpful.

The inclusion of a chapter on antipsychotic drugs, weight gain, and diabetes is timely. This chapter delves into the mechanisms by which atypical antipsychotic drugs may contribute to insulin resistance and diabetes. In a book targeted to the clinician, more attention might have been paid to potential ways to prevent and treat these consequences, which are discussed in only a few paragraphs. Additional review of the many other psychotropic medications that may contribute to weight gain would also have been useful.

There is much overlap between chapters, and the sometimes-differing interpretations of the same data may be confusing for the uninitiated reader. For example, when trying to determine whether the effect of sibutramine on pulse and blood pressure may change the risk–benefit ratio, a reader of the chapter titled “Basic Considerations and Guidelines for Treatment” is told that “noradrenergic agents have an effect on pulse and blood pressure, but this action tends to be neutralized by the opposite effect from weight loss.” However, the reality is that a similar amount of weight loss due to lifestyle changes will have a larger favorable impact on pulse and blood pressure than will weight loss due to the effects of certain weight-loss medications, such as sibutramine. This observation is correctly discussed in the following chapter, titled “Weight Loss and Cardiovascular Risk Factors.”

A possible limitation of this book about a fast-changing field is that it may be outdated by the time it is published. The editors have established a Web site (www.endo-diabasel.ch/BookAnti-obesitydrugs.htm) where they plan to post important developments related to the pharmacotherapy of obesity that may occur between published editions. Readers who are knowledgeable about this field will be acutely aware of the changes that took place while this book was in production. For example, in the chapter on herbal supplements, ephedra and ephedrine–caffeine are still discussed as treatment options, although the medications were withdrawn from the market in April 2004. In the chapter on drug targets, cannabinoid receptors are briefly discussed; however, rimonabant — currently in phase 3 clinical trials and of much interest to the reading public — is listed only by its research compound identifier (SR141716), and only animal data are discussed. Off-label use of medications that are approved for other purposes, such as topiramate and bupropion, gets only a brief, one-paragraph mention. Thus, many of the drugs that might be of most interest to treating physicians are not discussed in depth or the information that is presented is not current enough to be useful.

In sum, this book contains reasonably useful information regarding existing medications, but the information on drugs that are under development is not as useful. Members of the target audience — practicing clinicians — are not likely to find this book very useful as a manual for treating their obese patients, although students and researchers will find information that may be of use to them.

Susan Yanovski, M.D.
National Institutes of Health, Bethesda, MD 20892