Promising new approaches to the management of obesity

The pathophysiology of obesity is complex with many different pathways invo lved. A better understanding of these weight-regulating mechanisms has lead to the identification of new targets for anti-obesity agents. Most attenti on has been given to the centrally acting neuropeptides regulating food int ake. Leptin, playing a key-role, exerts its action through several neuropep tides such as neuropeptide Y, alpha-melanocyte stimulating hormone and agou ti related protein. Cocaine- and amphetamine-regulated transcript peptide a nd the orexins are the latest discovered peptides acting at the level of th e hypothalamus. Targets for new drugs acting on peptides secreted from the periphery are cholecystokinin and glucagon-like peptide 1. Another potentia l target in the treatment of obesity is increasing energy expenditure via b eta 3 adrenoceptors or uncoupling proteins. These new pharmacological agent s in development could be valuable adjuncts to more traditional treatment s trategies such as dietary treatment, behavioural/psychological counselling and physical activity.