Anti-obesity drugs: a critical review of current therapies and future opportunities.

The last 25 years have seen a great increase in the incidence of obesity, both in the Western world and in developing third world countries. Despite the seeming inexorable progression of this disease, there have been limited advances in the pharmacotherapy of this condition. Of the newest introductions to the obesity drug portfolio, orlistat, which acts to prevent dietary fat absorption, and sibutramine, which seems to affect both arms of the energy balance equation, were the first new chemical entities to be introduced for the treatment of obesity in 30 years. In this article, we review these and other agents available in various countries for the treatment of obesity. Perhaps more importantly, we have focussed on areas of potential productivity in the future. The huge recent increase in our knowledge in this area has largely stemmed from discovery research at the genomics level. Over the last 5 or so years, this impetus in obesity research has provided us with exciting new drug targets involved in the regulation of feeding behaviour and cellular mechanisms involved in energy expenditure. Compared with the last 25 years, the future offers more hope.