Información del artículo
Resumen
El tratamiento de la obesidad descansa fundamentalmente en la modificación de los factores ambientales (dieta, junto a una actividad física aeróbica regulary la modificación de hábitos de vida). En la práctica, la mayor parte del peso perdido se recupera a los 5 años en un elevado porcentaje de pacientes, particularmente entre los obesos mórbidos.
El objetivo del tratamiento médico debe centrarse en mejorar las comorbilidades asociadas a la obesidad, que pueden controlarse sustancialmente con pequeñas pérdidas de peso. Cualquier posibilidad de éxito pasa por un contacto continuado con una unidadespecializada de obesidad que incluya la aplicación y el seguimiento de las pautas más adecuadas y detecte al mismo tiempo las alteraciones psicopatológicas asociadas con la alimentación.
El tratamiento farmacológico adyuvante con sibutramina u orlistat, cuando no se alcanzan los objetivos planteados con la dieta, puede conseguir pérdidas de peso del 10% en un plazo de más de 2 años. Sin embargo, su elevado coste y la imposibilidad de mantenerlos indefinidamente limitan su efectividad.
Medidas como las dietas de muy bajo contenido calórico o la eventual colocación de un balón intragástrico pueden justificarse cuando se precisa perder peso de manera rápida e importante.
Probablemente, el tratamiento farmacológico futuro de la obesidad se base en la combinación de varios fármacos que actúen en diferentes niveles de control de la ingesta y/o termogénesis. Sin embargo, por ahora, sólo la cirugía bariátrica puede brindar una respuesta efectiva a largo plazo en la mayoría de los pacientes con obesidad mórbida.
Palabras clave:
Obesidad mórbida
Nutrición
Tratamiento farmacológico
Balón intragástrico
The treatment of obesity lies mainly in modification of environmental factors (diet, together with regular aerobic exercise and lifestyle changes). In practice, a high percentage of patients will regain most of the weight lost within 5 years, especially those that are morbidly obese.
Medical treatment should focus on improving obesity-related comorbidities, which can be substantially controlled with small weight losses. Any chance of success must include long-term contact with a specialized obesity unit that includes the application and follow-up of the most appropriate measures and is able to detect diet-related psychopathological alterations in time.
When dietary measures are not completely successful, adjuvant drug treatment with sibutramine or orlistat can achieve a 10% weight loss at 2 years. However, the high cost of these drugs and the impossibility of their indefinite intake limit their effectiveness.
Measures such as very low-calorie diets or insertion of an intragastric balloon can be justified when rapid and considerable weight loss is required.
Future drug treatment of obesity will probably be based on the combination of several drugs that act on different levels of appetite control and/or thermogenesis. However, at present, only bariatric surgery can offer an effective long-term solution in most morbidly obese patients.
Key words:
Morbid obesity
Nutrition
Pharmacological treatment
Intragastric baloon
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