| Summary: | Nonpharmacological approach to the prevention and treatment of obesity includes considerable lifestyle changes such as adequate physical exercise, smoking cessation, limiting alcohol intake, avoiding sedentary lifestyles, intensive behavioral counseling (psychotherapy), proper nutritional (dietary) programs, and bariatric surgery. For a pharmacotherapeutic substance to be regarded as an anti-obesity drug, it has to demonstrate a reduction of at least 5%–10% in the baseline body weight within a year of commencing treatment. Pharmacotherapeutic agents used to treat obesity include sympathomimetic appetite suppressant drugs, pancreatic lipase inhibitors, antidiabetic drugs, serotonin 5-HT2Cagonists, anticonvulsant drugs, atypical antidepressants, hormones, selective β3adrenoceptor agonists, and various combination preparations. The choice of agent should be individualized and dictated by patient comorbidities, relative contraindications, available clinical trial evidence, and clinical expertise. In addition to pharmacological therapy, all anti-obesity drugs should be prescribed with the premise of dietary caloric restriction and exercise. Bariatric surgery is the most effective treatment for obesity when the other forms of intervention have failed to produce a clinically significant weight loss in individuals with a body mass index of ≥35 kg/m2. Finally, concerning the prospective future research directions on the pharmacotherapy of obesity, a number of initiatives have been put forward to develop a peripherally restricted CB1receptor antagonist (such as TM38837 compound) that targets only the peripheral CB1receptors by restricting their ability to cross the blood–brain barrier in order to avoid the serious and severe psychiatric adverse effects found to be associated with the unrestricted CB1receptor antagonists such as rimonabant.
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