Editing Obesity (section)

=== Medication ===
{{Main|Anti-obesity medication}}
Since the introduction of medicines for the management of obesity in the 1930s, many compounds have been tried. Most of them reduce body weight by small amounts, and several of them are no longer marketed for obesity because of their side effects. Out of 25 anti-obesity medications withdrawn from the market between 1964 and 2009, 23 acted by altering the functions of chemical [[neurotransmitters]] in the brain. The most common side effects of these drugs that led to withdrawals were mental disturbances, cardiac side effects, and [[Substance abuse|drug abuse]] or [[drug dependence]]. Deaths were reportedly associated with seven products.<ref>{{cite journal | vauthors = Onakpoya IJ, Heneghan CJ, Aronson JK | title = Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review | journal = BMC Medicine | volume = 14 | issue = 1 | pages = 191 | date = November 2016 | pmid = 27894343 | pmc = 5126837 | doi = 10.1186/s12916-016-0735-y | doi-access = free }}</ref>

Five medications beneficial for long-term use are: [[orlistat]], [[lorcaserin]], [[liraglutide]], [[Phentermine/topiramate|phentermine–topiramate]], and [[naltrexone/bupropion|naltrexone–bupropion]].<ref name="NEJM 2017">{{cite journal | vauthors = Heymsfield SB, Wadden TA | title = Mechanisms, Pathophysiology, and Management of Obesity | journal = The New England Journal of Medicine | volume = 376 | issue = 3 | pages = 254–266 | date = January 2017 | pmid = 28099824 | doi = 10.1056/NEJMra1514009 | s2cid = 20407626 }}</ref> They result in weight loss after one year ranged from 3.0 to 6.7&nbsp;kg (6.6-14.8&nbsp;lbs) over placebo.<ref name="NEJM 2017" /> Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, phentermine–topiramate is available only in the United States.<ref name="EMA2013">{{cite journal | vauthors = Wolfe SM | title = When EMA and FDA decisions conflict: differences in patients or in regulation? | journal = BMJ | volume = 347 | pages = f5140 | date = August 2013 | pmid = 23970394 | doi = 10.1136/bmj.f5140 | s2cid = 46738622 }}</ref> European regulatory authorities rejected lorcaserin and phentermine-topiramate, in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate.<ref name="EMA2013" /> Lorcaserin was available in the United States and then removed from the market in 2020 due to its association with cancer.<ref>{{cite web |title=Belviq, Belviq XR (lorcaserin) by Eisai: Drug Safety Communication – FDA Requests Withdrawal of Weight-Loss Drug |url=https://www.fda.gov/safety/medical-product-safety-information/belviq-belviq-xr-lorcaserin-eisai-drug-safety-communication-fda-requests-withdrawal-weight-loss-drug |website=FDA |access-date=18 February 2020 |language=en |date=13 February 2020}}</ref> Orlistat use is associated with high rates of gastrointestinal side effects<ref name="Orli07">{{cite journal | vauthors = Rucker D, Padwal R, Li SK, Curioni C, Lau DC | title = Long term pharmacotherapy for obesity and overweight: updated meta-analysis | journal = BMJ | volume = 335 | issue = 7631 | pages = 1194–9 | date = December 2007 | pmid = 18006966 | pmc = 2128668 | doi = 10.1136/bmj.39385.413113.25 | type = Meta-analysis }}</ref> and concerns have been raised about negative effects on the kidneys.<ref>{{cite web| vauthors = Wood S |title=Diet Drug Orlistat Linked to Kidney, Pancreas Injuries |url= http://www.medscape.com/viewarticle/740855?src=mp&spon=30 |website=Medscape |publisher=Medscape News |access-date=26 April 2011}}</ref> There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death;<ref name="Yan2014" /> however, liraglutide, when used for type 2 diabetes, does reduce cardiovascular events.<ref>{{cite journal | vauthors = Lin CH, Shao L, Zhang YM, Tu YJ, Zhang Y, Tomlinson B, Chan P, Liu Z | title = An evaluation of liraglutide including its efficacy and safety for the treatment of obesity | journal = Expert Opinion on Pharmacotherapy | volume = 21 | issue = 3 | pages = 275–285 | date = February 2020 | pmid = 31790314 | doi = 10.1080/14656566.2019.1695779 | s2cid = 208610508 }}</ref>

In 2019 a [[systematic review]] compared the effects on weight of various doses of [[fluoxetine]] (60&nbsp;mg/d, 40&nbsp;mg/d, 20&nbsp;mg/d, 10&nbsp;mg/d) in obese adults.<ref name=":5">{{cite journal | vauthors = Serralde-Zúñiga AE, Gonzalez Garay AG, Rodríguez-Carmona Y, Melendez G | title = Fluoxetine for adults who are overweight or obese | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD011688 | date = October 2019 | pmid = 31613390 | pmc = 6792438 | doi = 10.1002/14651858.CD011688.pub2 | collaboration = Cochrane Metabolic and Endocrine Disorders Group }}</ref> When compared to placebo, all dosages of fluoxetine appeared to contribute to weight loss but lead to increased risk of experiencing side effects such as dizziness, drowsiness, fatigue, insomnia and nausea during period of treatment. However, these conclusions were from low certainty evidence.<ref name=":5" /> When comparing, in the same review, the effects of fluoxetine on weight of obese adults, to other [[Anorectic|anti-obesity agents]], [[Omega-3 fatty acid|omega-3]] gel and not receiving a treatment, the authors could not reach conclusive results due to poor quality of evidence.<ref name=":5" />

Among antipsychotic drugs for treating schizophrenia [[clozapine]] is the most effective, but it also has the highest risk of causing the [[metabolic syndrome]], of which obesity is the main feature. For people who gain weight because of clozapine, taking [[metformin]] may reportedly improve three of the five components of the metabolic syndrome: waist circumference, fasting glucose, and fasting triglycerides.<ref>{{cite journal | vauthors = Siskind DJ, Leung J, Russell AW, Wysoczanski D, Kisely S | title = Metformin for Clozapine Associated Obesity: A Systematic Review and Meta-Analysis | journal = PLOS ONE | volume = 11 | issue = 6 | pages = e0156208 | date = 15 June 2016 | pmid = 27304831 | pmc = 4909277 | doi = 10.1371/journal.pone.0156208 | bibcode = 2016PLoSO..1156208S | doi-access = free | veditors = Holscher C }}</ref>