DRUG-THERAPY FOR OBESITY IN THE ELDERLY

The prevalence of obesity is increasing rapidly in the US and other de veloped countries. Even though the percentage of older individuals is increasing worldwide, obesity has only recently become a recognised pr oblem in this population. Obesity occurs when energy intake chronicall y exceeds energy expenditure. Moreover, advancing age is associated wi th an inability to couple energy intake with energy expenditure. Obesi ty contributes to many adverse health outcomes, including non-insulin- dependent (type II) diabetes mellitus, as well as to an increase in bo th cardiovascular and all-cause mortality. Only recently has the medic al community begun to accept obesity as a disease with a multifactoria l pathogenesis that requires systematic lifestyle changes and pharmaco logical treatment. Several groups of drugs are available for the pharm acotherapy of obesity:anorectic medications (e.g. fenfluramine, dexfen fluramine); substances affecting energy expenditure and body compositi on [e.g. chromium (chromium picolinate), ephedrine, anabolic steroids, beta(3)-adrenoceptor agonists]; and drugs affecting the absorption of nutrients (e.g. orlistat). To date, few drugs have produced and susta ined a significant bodyweight loss. However, some drugs induce a signi ficant short term reduction in bodyweight compared with placebo. Moreo ver, there is a paucity of information regarding the effectiveness of these drugs in the treatment of obesity in the elderly. Furthermore, i t is even debated whether obesity should be treated with drug interven tion in the elderly. Clinicians prescribing medications for obesity tr eatment in the elderly need to carefully consider the benefit: risk ra tio, given the high prevalence of polypharmacy in elderly patients. Fu rthermore, physiological changes that occur with aging may affect the pharmacokinetics of administered drugs and need to be taken into consi deration.