Excess body weight and obesity as a side effect of medications

Background . Drug-induced weight gain is a common adverse effect of many medications used in everyday clinical practice. It contributes to the overall picture of lipid metabolism disorders, may reduce adherence to treatment, including treatment discontinuation with relapse of the underlying disease, and increases the risk of hypertension, type II diabetes mellitus, cardiovascular complications and certain cancers. Objective . To summarize literature data on medications associated with overweight and obesity and to draw clinicians’ attention to drug-related causes of weight gain. Methods . A narrative review of the literature on drug-induced weight gain and obesity. Data on medications, mechanisms of weight gain and clinical consequences were analyzed and summarized. Key content and findings . Glucocorticosteroids, insulin, growth hormone, hormonal contraceptives, psychotropic medications (anticonvulsants, antidepressants, antipsychotics, anxiolytics and sedatives), antihypertensive drugs, antibacterial agents and combination antiretroviral therapy are discussed. Possible mechanisms are considered: increased appetite and altered food preferences, effects on leptin and neuropeptide Y, insulin resistance, reduced physical activity and lipolysis, and influence on the gut microbiota. It is emphasized that drug-induced obesity is not merely a cosmetic issue but is associated with comorbidity and worse prognosis. Conclusions . Drug-induced obesity is a multifactorial condition requiring clinicians’ awareness, timely detection of weight gain during pharmacotherapy and, when necessary, selection of drugs with a more favorable metabolic profile.