Use of GLP-1 analogs in the treatment of obesity: an integrative and systematic review

Obesity is the global epidemic of the 21st century: about 1.5 billion adults worldwide are overweight, and among them, about 200 million men and 300 million women are obese. The prevalence of overweight and obesity is also increasing in children and adolescents in developed (about 25%) and developing countries (about 13%). Obesity has been associated with many comorbidities, including type 2 diabetes mellitus (T2DM), nonalcoholic fatty liver disease (NAFLD), hypertension, chronic kidney disease, cardiovascular disease (CVD), and malignancies, leading to increased mortality observed in obese individuals. Overweight and obesity were estimated to be associated worldwide with 3.4 million deaths, which could also be expressed as 4% of disability-adjusted life-years lost (DALYs). It is also alarming that children with severe obesity are apparently at in- creased risk of premature death. Managing obesity is hard and usually disappointing for both patients and physicians. Weight loss is difficult to achieve and even more difficult to sustain in the long term. When lifestyle modifications fail to achieve the predefined target, anti-obesity medications may be added on, as recommended by all relevant guidelines, including those of the Endocrine Society and recent guidelines for obese with diabetes. Glucagon-like peptide 1 (GLP-1) is an incretin secreted by L-cells in the intestinal mucosa and has been shown to act in the brain and periphery to cause effective weight loss. GLP-1 release is stimulated by food intake and its agonist, exenatide, is the first from the incretin family approved for weight-loss therapy by the Food and Drug Administration (FDA). In overweight and obese adults, it is concluded that the GLP-1 analogs and the Phentermine/Topiramate association proved to be among the best for the effects on weight reduction. Regarding childhood obesity, the FDA recently approved the use of Liraglutide. Schizophrenic patients, a target of studies due to risk factors, benefited from treatment with GLP-1 analogs.