OBESITY: A GASTROENTEROLOGIST’S POINT OF VIEW AND VARIANTS OF MEDICAL THERAPY

Background: One of the main pathophysiological features of metabolic syndrome is abdominal obesity which forms the basis of metabolic syndrome associated disorders, such as disorders of carbohydrate metabolism and atherogenic dyslipoproteinemia. Abdominal obesity and metabolic disturbances promote the development of constellation of various disorders, like that of the liver (non-alcoholic fatty disease), biliary tract, heart, as well as pancreas (with formation of steatosis). This makes an obese patient polimorbid and significantly complicates his/hers treatment. Therefore, development of modern and safe approaches to treatment of obesity, with consideration of individual characteristics of metabolic abnormalities, seems to be highly relevant.

 Aim: To assess efficacy and safety of a combined product of sibutramine and microcristallic cellulose (Reduxin®) in patients with alimentary constitutional obesity resistant to medical treatment, as well as to identify factors that influence efficacy of sibutramine in this patient category.

 Materials and methods: Forty patients (25 males and 15 females) with grade II–III obesity resistant to medical treatment participated in the study. Mean age of patients was 36.8 ± 10.4 years. Their clinical and laboratory assessment, beyond standard parameters, included measurement of insulin resistance index, leptin levels, assessment of vasomotor endothelial function, type of eating behavior and gut microflora. Weight reduction program was based on hypocaloric diet, regular physical exercise of moderate intensity and treatment with sibutramine (Reduxin®) 15 mg daily for 6 months. Efficacy of treatment was assessed as reduction of body mass by ≥ 5% from baseline within 3 months of treatment.

Results: After 3 months of treatment, effective reduction of body mass by ≥ 10% was seen in 80% of patients. After 6 months from the study start, 100% of patients achieved and maintained effective reduction of body weight by 10.6 to 20.2% from baseline values. Patients with whom treatment was least effective, had higher insulin resistance index (r = 0.32, p < 0.05), higher leptin levels (r = 0.42, p < 0.05), higher degree of liver steatosis on ultrasound examination (r = 0.38, p < 0.05), higher proportion of patients with emotionally triggered eating behavior (r = 0.29, p < 0.05), as well as more advanced dysbiotic abnormalities of gut microflora (r = 0.27, p < 0.05). To decrease dysbiotic abnormalities of the gut, patients with previous lack of treatment efficacy were administered a prebiotic complex Eubicor®. 24-hour ambulatory blood pressure monitoring and electrocardiographic monitoring before the start of the treatment allowed to avoid significant side effects with daily sibutramine dose of 15 mg. During treatment with sibutramine, the following potentially related side effects were reported: dryness of mouth (6 cases in 15% of patients), episode of tachycardia at rest (2 cases, 5% patients), transient sleep disorder (3 cases, 7.5% patients).

Conclusion: Sibutramine can be considered as an effective and safe agent for comprehensive treatment of patients with alimentary constitutional obesity grade II–III, resistant to previous medical therapy. Addition of the prebiotic complex (Eubicor®) to diet allows for improvement of treatment efficacy in patients taking Reduxin®.