비만의 행동중재와 약물치료
Behavioral Intervention and Anti-Obesity Drug Therapy
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초록
비만이 심각한 사회 문제라는 것은 잘 알려져 있다. 하지만 이를 획기적으로 치료할 수 있는 방법은 많지 않다. 행동중재 치료의 경우 4년 추적한 연구결과에 따르면 혈당을 포함한 심혈관계 위험인자들이 개선되었다. 하지만 체중 감소량 자체가 크지 않고 오랜 기간 동안 이를 유지하는 것이 어렵다는 문제가 있다. 국내에서는 체질량지수가 25 이상이거나 23 이상이면서 비만관련 합병증이 있는 경우 약물치료를 시도해 볼 수 있다. 하지만 현재 처방 가능한 약물은 매우 제한적이라고 할 수 있다. 비만약제의 경우에는 치료 약제의 부작용 관련 문제, 약제의 비용문제가 있을 수 있다. 국내에서 사용 가능한 약제로는 올리스타트, 펜터민, 디에틸프로피온, 펜디메트라진, 마진돌이 있다. 최근 미국 식품의약품안전청에서 로카세린과 펜터민/토피라메이트 복합제가 새로운 비만치료제로 허가되었다. 이러한 약제의 경우 국내 임상데이터가 축적되면 국내에서도 사용 가능할 것으로 생각한다.
Abstract
Obesity is associated with a reduction in life expectancy and an increase in mortality from cardiovascular diseases, cancer, and other causes. The U.S. Preventive Service Task Force (USPSTF) recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. Behavioral interventions can lead to a moderate weight loss and improvement in blood sugar and other risk factors for cardiovascular disease. Behavioral interventions decreased the incidence of diabetes diagnosis by about 50% over 2 to 3 years. Orlistat, phentermine, diethylpropion, phendimetrazine, mazindol have been approved as anti-obesity drugs by Korea Food and Drug Administration. The U.S. Food and Drug Administration approved lorcaserin and phentermine plus topiramate combination for treatment of obesity in 2012.
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