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Article: Pharmacotherapy for obesity: moving towards efficacy improvement.

Coutinho, Walmir / Halpern, Bruno

2024 Volume 16, Issue 1, Page(s) 6

Abstract: Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with ... ...

Abstract	Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with increasing weight-related comorbidities and deaths worldwide. Lifestyle interventions alone provide clinically significant long-term weight loss in only a small proportion of individuals, and bariatric surgery is not suitable or desirable for all patients. Historically, anti-obesity medications achieved a mean efficacy with weight loss between 5 and 10%, which significantly impacted several comorbidities and risk factors, but the average efficacy of these medications remained lower than that expected by both patients and health care professionals and eventually curbed long-term use. Moreover, there is no direct evidence on the impact of anti-obesity medications on cardiovascular outcomes. Semaglutide is a newer anti-obesity medication that changes the overall landscape, as phase 3 studies show a mean weight loss near the 15% threshold and significant proportions of patients with a weight loss of greater than 20%. In this review, we focus on the currently available anti-obesity medications, discuss the results of semaglutide, and present perspectives on the future of obesity treatment after semaglutide.
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2518786-7
ISSN	1758-5996
ISSN	1758-5996
DOI	10.1186/s13098-023-01233-4
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Bridging the Gap: Psychiatry's Role in the New Era of Obesity Treatment.

Appolinario, Jose Carlos / Hay, Phillipa / Coutinho, Walmir

Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)

2024

Language	English
Publishing date	2024-04-08
Publishing country	Brazil
Document type	Editorial
ZDB-ID	2024119-7
ISSN	1809-452X ; 1809-452X
ISSN (online)	1809-452X
ISSN	1809-452X
DOI	10.47626/1516-4446-2024-3604
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Article ; Online: The first decade of sibutramine and orlistat: a reappraisal of their expanding roles in the treatment of obesity and associated conditions.

Coutinho, Walmir

Arquivos brasileiros de endocrinologia e metabologia

2009 Volume 53, Issue 2, Page(s) 262–270

Abstract: Ancillary therapies for weight management, consisting mainly of diet and exercise programs that incorporate variable levels of lifestyle modification techniques, are frequently ineffective to achieve clinically meaningful weight loss and maintenance. ... ...

Abstract	Ancillary therapies for weight management, consisting mainly of diet and exercise programs that incorporate variable levels of lifestyle modification techniques, are frequently ineffective to achieve clinically meaningful weight loss and maintenance. Although pharmacological treatment of obesity is widely used in most countries, the number of available drugs is still very limited. The most widely used anti-obesity agents are sibutramine and orlistat, both available in clinical practice for about a decade. A large number of clinical trials have demonstrated that both agents are safe and well tolerated, with a level of efficacy in the moderate weight loss recommended by the most relevant clinical guidelines. Several studies have assessed the efficacy and safety of sibutramine and orlistat in adolescents and also for the treatment of some associated conditions in adults, including type 2 diabetes, polycystic ovary syndrome and binge eating disorder. The positive results of these studies suggest an expanding role for both agents, not only for the treatment of obesity, but also for associated conditions. After the efficacy of orlistat for the prevention of type 2 diabetes demonstrated in the XENDOS study, the results of SCOUT study are awaited for a better evaluation of sibutramine impact on cardiovascular outcomes.
MeSH term(s)	Adolescent ; Adult ; Anti-Obesity Agents/therapeutic use ; Appetite Depressants/therapeutic use ; Clinical Trials as Topic ; Cyclobutanes/therapeutic use ; Evidence-Based Medicine ; Humans ; Lactones/therapeutic use ; Obesity/drug therapy ; Orlistat ; Practice Guidelines as Topic ; Weight Loss/drug effects ; Weight Loss/physiology
Chemical Substances	Anti-Obesity Agents ; Appetite Depressants ; Cyclobutanes ; Lactones ; Orlistat (95M8R751W8) ; sibutramine (WV5EC51866)
Language	English
Publishing date	2009-04-15
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302009000200018
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Article ; Online: The first decade of sibutramine and orlistat

Walmir Coutinho

Arquivos brasileiros de Endocrinologia e Metabologia, Vol 53, Iss 2, Pp 262-

a reappraisal of their expanding roles in the treatment of obesity and associated conditions A primeira década da sibutramina e do orlistate: reavaliação do seu crescente papel no tratamento da obesidade e condições associadas

2009 Volume 270

Abstract	Ancillary therapies for weight management, consisting mainly of diet and exercise programs that incorporate variable levels of lifestyle modification techniques, are frequently ineffective to achieve clinically meaningful weight loss and maintenance. Although pharmacological treatment of obesity is widely used in most countries, the number of available drugs is still very limited. The most widely used anti-obesity agents are sibutramine and orlistat, both available in clinical practice for about a decade. A large number of clinical trials have demonstrated that both agents are safe and well tolerated, with a level of efficacy in the moderate weight loss recommended by the most relevant clinical guidelines. Several studies have assessed the efficacy and safety of sibutramine and orlistat in adolescents and also for the treatment of some associated conditions in adults, including type 2 diabetes, polycystic ovary syndrome and binge eating disorder. The positive results of these studies suggest an expanding role for both agents, not only for the treatment of obesity, but also for associated conditions. After the efficacy of orlistat for the prevention of type 2 diabetes demonstrated in the XENDOS study, the results of SCOUT study are awaited for a better evaluation of sibutramine impact on cardiovascular outcomes. A terapia anciã para controle do peso, que consiste principalmente em programas de dieta e exercício incorporando técnicas de mudança de estilo de vida de diversos níveis distintos, é frequentemente ineficaz em atingir uma perda e manutenção de peso clinicamente significativas. Apesar de amplamente utilizado na maioria dos países o tratamento farmacológico da obesidade, o número de medicamentos disponíveis ainda é muito limitado. Os agentes antiobesidade mais utilizados são a sibutramina e o orlistate, ambos disponíveis na prática clínica há cerca de uma década. Em um grande número de ensaios clínicos já se demonstrou que ambos agentes são seguros e bem tolerados, com um nível de eficácia consistente de perda de peso moderada que se recomenda nas principais diretrizes clínicas. Vários estudos avaliaram a eficácia e segurança da sibutramina e do orlistate em adolescentes e também para o tratamento de algumas condições associadas em adultos, incluindo o diabetes tipo 2, a síndrome dos ovários policísticos e o transtorno da compulsão alimentar periódica. Os resultados positivos desses estudos sugerem que o papel dos dois medicamentos deverá ser expandido não apenas para o tratamento de um maior número de pacientes obesos, mas também para o tratamento de condições associadas. Depois que o orlistate teve sua eficácia demonstrada na prevenção do diabetes tipo 2 por meio do estudo XENDOS, os resultados do SCOUT são aguardados para uma melhor avaliação do impacto da sibutramina sobre os desfechos cardiovasculares.
Keywords	Obesidade ; tratamento farmacológico ; sibutramina ; orlistate ; segurança ; eficácia ; perda de peso ; Obesity ; pharmacological treatment ; sibutramine ; orlistat ; safety ; efficacy ; weight loss ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2009-03-01T00:00:00Z
Publisher	Sociedade Brasileira de Endocrinologia e Metabologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Obesity prevention in Brazil.

Coutinho, Walmir

The West Indian medical journal

2003 Volume 51 Suppl 1, Page(s) 36–37

MeSH term(s)	Brazil/epidemiology ; Government Programs ; Humans ; Life Style ; Nutritional Status ; Obesity/epidemiology ; Obesity/prevention & control
Language	English
Publishing date	2003-02-03
Publishing country	Jamaica
Document type	Congress
ZDB-ID	131067-7
ISSN	0043-3144
ISSN	0043-3144
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Epidemiological study of metabolic syndrome in Brazilian soldiers

Marcos de Sá Rego Fortes / Samir Ezequiel da Rosa / Walmir Coutinho / Eduardo Borba Neves

Archives of Endocrinology and Metabolism, Iss

2019

Abstract: ABSTRACT Objective: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Subjects and methods: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated ... ...

Abstract	ABSTRACT Objective: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Subjects and methods: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). Results: The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). Conclusion: Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.
Keywords	Metabolic syndrome ; abdominal obesity ; dyslipidemia ; hypertension ; hyperglycemia ; Medicine ; R ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665
Subject code	610
Language	English
Publishing date	2019-03-01T00:00:00Z
Publisher	Brazilian Society of Endocrinology and Metabolism
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Diabetes Care in Brazil

Walmir F Coutinho / Wellington Santana Silva Júnior

Annals of Global Health, Vol 81, Iss 6, Pp 735-

2016 Volume 741

Abstract: Background The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the ... ...

Abstract	Background The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the region and the diagnostic criteria adopted in each study. Objective To provide an overview of diabetes care in Brazil, focusing on studies of diabetes epidemiology, prevalence of patients within the standard targets of care, and economic burden of diabetes and its complications. Methods SciELO and PubMed searches were performed for the terms “diabetes,” “Brazil,” “Brazilian,” and “health system”; relevant literature from 1990 to 2015 was selected. Additional articles identified from reference list searches were also included. All articles selected were published in Portuguese and/or English. Findings Recent studies detected a prevalence of gestational diabetes mellitus of nearly 20%. Among patients with type 1 diabetes, almost 90% fail to reach target of glycemic control, with less than 30% receiving treatment for both hypertension and dyslipidemia. More than 75% of patients with type 2 diabetes are either overweight or obese. Most of these patients fail to reach glycemic targets (42.1%) and less than 30% reached the target for systolic and diastolic blood pressure, body mass index, or low-density lipoprotein cholesterol. Only 0.2% of patients reach all these anthropometric and metabolic targets. Conclusions Brazil is the fourth country in the world in number of patients with diabetes. Regardless of the diabetes type, the majority of patients do not meet other metabolic control goals. The economic burden of diabetes and its complications in Brazil is extremely high, and more effective approaches for preventions and management are urgently needed.
Keywords	Brazil ; diabetes ; diabetes care ; health care expenditures ; Latin America ; public health care ; type 2 diabetes ; Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
Subject code	571
Language	English
Publishing date	2016-04-01T00:00:00Z
Publisher	Ubiquity Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effectiveness of Pharmacologic Interventions in the Management of Weight Gain in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis.

Hiluy, Joao C / Nazar, Bruno P / Gonçalves, Walter S / Coutinho, Walmir / Appolinario, Jose C

The primary care companion for CNS disorders

2019 Volume 21, Issue 6

Abstract: Objective: To collate and analyze randomized controlled trials (RCTs) that evaluated pharmacologic interventions to reduce weight gain in patients with severe mental illness (SMI).: Data sources: Searches were conducted in PubMed, Web of Science, and ...

Abstract	Objective: To collate and analyze randomized controlled trials (RCTs) that evaluated pharmacologic interventions to reduce weight gain in patients with severe mental illness (SMI). Data sources: Searches were conducted in PubMed, Web of Science, and PsycINFO databases from inception through May 9, 2019, using the terms ("severe mental disease" OR "severe mental illness" OR "severe mental disorder" OR schizophre* OR bipolar OR antipsychotic) AND (weight) AND (pharmacologic OR treatment). There was no language restriction, and the electronic search was complemented by a manual search for additional articles in reference lists and previous reviews. Study selection: Fifty-two studies investigating different pharmacologic weight loss interventions in SMI were retrieved. Only RCTs assessing pharmacologic interventions to manage weight gain in adult subjects with SMI and reporting change in body weight as a primary outcome were included. Data extraction: Two reviewers independently extracted data about the name and dose of the pharmacologic agent used to manage weight gain, trial duration, agent used for index disease, psychiatric diagnostics, and the mean change in body weight over the course of the trial. A meta-analysis was performed using a random effects model to pool mean body weight change over the course of the trial. Results: The most-studied agent was metformin (14 studies), followed by topiramate (6 studies), nizatidine (4 studies), and sibutramine (3 studies). Other agents were investigated in 1 or 2 isolated studies. A meta-analytical procedure showed a significant pooled mean difference of -3.27 kg (95% CI, -4.49 to -2.06) for metformin compared with placebo and -5.33 kg (95% CI, -7.20 to -3.46) favoring topiramate. Conclusions: Metformin and topiramate were the most-studied agents for weight control in SMI and were considered efficacious and safe in promoting weight reduction compared to placebo in this population. More studies are required with larger sample sizes and in line with the recommendations from research from the obesity and metabolic field to better define guidelines for use of pharmacologic interventions to reduce weight gain in patients with SMI.
MeSH term(s)	Clinical Trials as Topic ; Humans ; Mental Disorders/complications ; Mental Disorders/physiopathology ; Obesity/complications ; Obesity/drug therapy ; Obesity/physiopathology ; Treatment Outcome ; Weight Gain
Language	English
Publishing date	2019-12-19
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2675414-9
ISSN	2155-7780 ; 2155-7780
ISSN (online)	2155-7780
ISSN	2155-7780
DOI	10.4088/PCC.19r02483
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Article ; Online: Epidemiological study of metabolic syndrome in Brazilian soldiers.

Fortes, Marcos de Sá Rego / Rosa, Samir Ezequiel da / Coutinho, Walmir / Neves, Eduardo Borba

Archives of endocrinology and metabolism

2019 Volume 63, Issue 4, Page(s) 345–350

Abstract: Objective: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers.: Subjects and methods: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from ... ...

Abstract	Objective: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Subjects and methods: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). Results: The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). Conclusion: Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.
MeSH term(s)	Adult ; Biomarkers ; Blood Glucose/analysis ; Blood Pressure ; Body Mass Index ; Brazil ; Cholesterol, HDL/blood ; Cross-Sectional Studies ; Humans ; Male ; Metabolic Syndrome/epidemiology ; Military Personnel/statistics & numerical data ; Odds Ratio ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Triglycerides/blood ; Waist Circumference ; Young Adult
Chemical Substances	Biomarkers ; Blood Glucose ; Cholesterol, HDL ; Triglycerides
Language	English
Publishing date	2019-03-21
Publishing country	Brazil
Document type	Journal Article ; Observational Study
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-3997000000115
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Sibutramine: balanced judgment or prejudice?

Coutinho, Walmir / James, W Philip T

Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)

2011 Volume 33, Issue 2, Page(s) 115–116

MeSH term(s)	Appetite Depressants/adverse effects ; Blood Pressure/drug effects ; Body Weight/drug effects ; Cyclobutanes/adverse effects ; Humans ; Judgment ; Obesity/drug therapy ; Prejudice ; Randomized Controlled Trials as Topic ; Risk Assessment
Chemical Substances	Appetite Depressants ; Cyclobutanes ; sibutramine (WV5EC51866)
Language	English
Publishing date	2011-06-25
Publishing country	Brazil
Document type	Editorial
ISSN	1809-452X
ISSN (online)	1809-452X
DOI	10.1590/s1516-44462011000200004
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