Pharmacological Therapy of Obesity: Past, Present, and Future

There is probably no medical condition for which a safe and effective form of pharmacotherapy is more highly desired than obesity. Neither is there a condition for which effective treatment would spare so much suffering for so many individuals. There is abundant evidence from epidemiological and interventional studies to suggest that morbidity from diabetes, cardiovascular disease, cerebrovascular disease, osteoarthritis, sleep apnea, and certain cancers could all be reduced in proportion to a reduction in body fat content. Past forms of pharmacotherapy for obesity have often been misguided, and currently available drugs are less effective than we would like them to be. However, our growing understanding of peripheral signals and central nervous system (CNS) pathways involved in the regulation of adiposity makes it very likely that effective new drugs will become available to treat obesity in the near future. This review will provide a brief history of obesity pharmacotherapy, discuss the status of currently available obesity drugs, and outline the major physiological pathways that will form the targets for future drug development.