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The Role Medication Plays in Treating Obesity

By Max Macaluso - Apr 9, 2013 at 6:30PM

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Diet and exercise are just part of the weight-management equation. Sometimes, treatment also involves prescription drugs.

Last summer, the Food and Drug Administration approved two new medications for the treatment of obesity. VIVUS' (VVUS) Qsymia has already reached the market, while Arena Pharmaceuticals' (ARNA) Belviq will be launched by its commercialization partner Eisai once the drug clears DEA scheduling. A third player, Orexigen Therapeutics (NASDAQ: OREX), is still developing its drug Contrave. The fact that obesity affects more than a third of American adults today has attracted many biotech investors to these stocks, but many may not fully understand how physicians approach treatment for this disease. For instance, are exercise and diet all patients really need to manage their weight?

To help clarify this complex topic, Motley Fool health-care analyst Max Macaluso spoke with Dr. Domenica Rubino, a weight-management expert and representative of The Obesity Society. In the following segment from their discussion, Dr. Rubino discusses the role that drugs play in treating obesity. A transcript follows the video.

The relevant video segment can be found between 5:20 and 8:17.

Max Macaluso: Let's pivot the discussion to drugs and treatment now. Arena recently got Belviq approved. It's not on the market yet. Vivus got Qsymia approved, and Orexigen is still developing Contrave. What role do drugs really play in treatment?

Dr. Domenica Rubino: A fundamental thing to understand is that the physiology of obesity is actually very complicated. Just as I was saying there are multiple causes of obesity, there are multiple factors that protect weight.

What people don't really understand is that the body is totally focused on holding onto weight, at all costs. People like to say, "Well, you just eat less, move more." It's not as simple as that, because when we do lose weight -- and countless people who struggle with this lose weight -- there are a lot of mechanisms that kick in.

There are endocrine signals coming from the fat cells, muscle cells, the GI tract, all to the brain to say, "Hold onto that weight."

What happens to that person is they get hungrier, they don't really want to move, certain foods look much more appealing, certain parts of the brain are lighting up, thinking, "Oh, I want that."

What else can happen is that people start to lose their sense of portion. The same subject, before weight loss and after weight loss, will not be able to estimate that portion anymore. Your body is in full-court press to regain weight.

That's where these medications can be really helpful. They augment our toolbox, as physicians, because primarily what we work with is helping people make lifestyle changes, identifying those factors that I was talking about.

Do they have sleep apnea? Well, they need to get sleep treated. Do they have difficulty moving? They need to get physical therapy and start getting some activity. They need to start changing their diet.

But beyond that, what happens is people do those changes, but then they come up against these physiologic factors, like they get incredibly hungry or they find themselves very obsessed in particular about some foods, and that's where medication can really help us. These medications that are being developed are targeting specific areas of the brain to try to help an individual with that.

You can have people who can lose weight without medication, but they might need medication to help them maintain the weight loss when, in that first two-year period, we're really vulnerable to regaining because all of these chemicals are coming back to our brain, saying: "Hey, something bad just happened. We just lost 60 pounds so we've got to do something about this." Medicines can be very helpful there.

For somebody who really is trying to make these changes but they can't seem to get going, medications can help those people as well.

As physicians, it just adds to our toolbox. For a given individual and a given situation, we might select a particular drug. It may be that that person stays on that medication for a very long time, or it may be that they need that medication temporarily, to start making those lifestyle changes.

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