Liraglutideas Adjunct Therapy in the Management of Obesity

Eugenio Cersosimo, Durval Ribas Filho


The obesity epidemic has reached a new level with some impressive numbers recently published in
the United States of America. Even more alarming is the rapid increase in childhood obesity, which
has been universally documented over the past few decades. The reasons underlying the problem of
obesity can be simplified into three categories: i) routine consumption of bigger portion size meals; ii)
confusing messages from food industry to consumers; and iii) physical inactivity is the “new normal”.
Considering that the medical consequences of obesity are serious and directly affect morbidity and
mortality, it has become necessary to act concomitantly to prevent and treat the increase in body weight
and fat excess accumulation. The prevention of obesity is a formidable task that can only be accomplished
with a concerted effort put together by several governmental agencies, especially those interested
in agriculture, health and education, the food industry and health care providers, including physicians
and nutrition specialists. Treatment of obesity with behavioral management, nutritional manipulations
(“diets”) and, even bariatric surgery has had some success, but these strategies are accompanied by
limited benefits and only to a select group of individuals. More importantly, the overall impact of these
on the growing obesity pandemic is disappointing, at best. Some dietary recommendations with caloric
restriction and adjustments in nutrient intake combined to pharmacotherapy have expanded our ability
to manage obese patients.The recent approval by the U.S. Food and Drug Administration (FDA) agency
of the Glucagon-Like-Peptide-1 (GLP-1) receptor analog liraglutide, at the dose of 3.0 mg once daily,
has provided us with an additional tool to combat the disease and minimize its complications. In this
particular study, a significant reduction in the conversion ratesfrom pre-diabetes to diabetes was also
shown and represents an important findingof the trial. Despite the fact that nausea, vomiting and diarrhea
were frequently reported during the 1-year period of observation, tolerance was acceptable and
most subjects completed the study.These data clearly indicate that combination drug therapy with dietary
adjustments can be successful in promoting weight reduction and further support routine utilization
of adjuvant pharmacotherapy in the management of obesity.


Obesity, GLP-1 RA, Liraglutide, Pre-Diabetes

Full Text:



Obesity in America.

-awareness,consulted in August 2015.

Ogden CL, Caroll MD, Kit BK, Flegal KM. Prevalence of

childhood and adult obesity in the United States, 2011-

JAMA 2014; 311 (8): 806-14.

Razak F, Arnad SS, Shannon H, et al. Defining obesity

cut points in a multiethnic population. Circulation 2007;


National Health and Nutrition Examination Survey. Obesity

and Socioeconomic Status in Adults; United States,

-2008. NHCS Data Brief No 50, December 2010.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular

disease: risk factor, paradox and impact of weight

loss. J Am Coll Cardiol. May 2009; 26: 53 (21): 1925-32.

Mathew B, Francis L, Kayalar A, Cone J. Obesity: effects

on cardiovascular disease and its diagnosis. J Am Board

Fam Med. 2008; 21(6):462-8.

Ludka O, Konecny T, Somers V, Massumi A. Sleep Apnea,

Cardiac Arrhythmias and Sudden Death. Tex Heart

Inst. J. 2011; 38(4):34-43.

Marchesini G, Natale S, Tiraferri F, Tartaglia A, Moscatiello

S, Marchesini RL, Villanova N. Forlani G, Melchionda

N. The burden of obesity on everyday life: a role for

osteoarticular and respiratory diseases. Diabetes Nutr

Metab. 2003; 16(5-6):284-90.

Vaidya V. Psychosocial aspects of obesity. Ad. Psychosom.

Med. 2006; 27:73-85.

Jiang J, Ahn J, Huang WY, Hayes RB. Association of

obesity with cardiovascular disease mortality in the PLCO

trial. Prev Med. Jul 2013; 57 (1):60-4.

Golan M. Parents as agents of change in childhood obesity

–from research to practice. International J. Ped Obesity

; 1(2): 66-76.

Tate DF, Jackvony EH, Wing RR. Effect of internet behavioral

counseling on weight loss in adults a risk for type 2

diabetes: a randomized trial. JAMA 2003; 289: 1833-36.

Shai I, Schwartzfuchs D, Henkin Y, et al. Dietary Intervention

Randomized Controlled Trial (DIRECT) Group.

Weight loss with a low-carbohydrate, Mediterranean or

low-fat diet. N Engl J Med. 2008; 359: 229-41.

Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight

loss diets with different compositions of fat, protein

and carbohydrates. N Engl J Med. 2009; 360: 859-73

Golay A, Eigenheer C, Morel Y, Kujawski P, Lehman T, de

Tonnac MN. Weight loss with low or high carbohydrate

diet? Int J Obes Relat Metab Disord. 1996; 20: 1067-72.

De Fronzo RA, Triplitt C, Abdul-Ghani M, Cersosimo E.

Novel Agents for the Treatment of Type 2 Diabetes.Diabetes

Spectrum, May 2014; (2):100-12.

MacLean PS, Higgins JA, Wyatt HR, et al. Regular exercises

attenuates the metabolic drive to regain weight after

long-term weight loss. Am J Physiol Regula Integr. Comp

Physiol. 2009; 297:R793-R802.

Sjostrom L, Narbro K, Sjostrom CD. Swedish Obese

Subjects Study. Effects of bariatric surgery on mortality in

Swedish obese subjects. N Engl J Med. 2007; 357:741-

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery

versus intensive medical therapy in obese patients

with diabetes. N Engl J Med. 2012;366:156-76.

Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric Surgery

and long-term cardivascular events. JAMA 2012;

: 56-65.

Rosenbaum M, Goldsmith R, Bloomfield D, et al. Low-

-dose leptin reverses skeletal muscle, autonomic and

neuroendocrine adaptations to maintenance of reduced

weight. J Clin Invest2005; 115:357-86.

Wadden TA, Berkowitz RI, Womble LG, et al. Randomized

trial of lifestyle modifications and pharmacotherapy

for obesity. New Engl J Med 2005; 353: 2111-20.

Smith SR, Aronne LJ, Burns CM, Kesty NC, Halseth Ae,

Weyer C. Sustained weight loss following 12-month pramlintide

treatment as an adjunct to lifestyle intervention in

obesity. Diabetes Care 2008; 31:1816-23.

Kim GW, Lin JE, Blomainn ES, Waldman SA. Anti-obesity

pharmacotherapy; new drugs and emerging targets. Clin

Pharmacol Ther. 2014; 95:53-66.

Pi-Sunyer X, Astrup A, Fujioka K, A randomized,

controlled trial of 3.0 mg of liraglutide in weight management.

N Engl J Med 2015; 373:11-22.

Cersosimo E, Gastaldelli A, Cervera A, et al. Effect of

exenatide on splanchnic and peripheral glucose metabolism

in type 2 diabetic subjects. J Clin Endo Metab. 2011;


Daniele G, Iozzo P, Molina-Carrion M, et al. Exentaide

increases brain glucose metabolism except inhypothalamus.

Diabetes 2015; June 26, pi: db 141718 [Epub ahead

of print].

Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes

Prevention Program Research Group. Reduction in

the incidence of type 2 diabetes with lifestyle intervention

or metformin. N Engl J Med 2002; 346:393-403.

Chiasson JL, Josse RG, Gomis R, et al. STOP-NIDDM

Trial Research Group. Acarbose for prevention of type

diabetes mellitus: the STOP-NIDDM randomized trial.

Lancet 2002; 359:2072-77.

Buchanan TA, Xiang AH, Peters RK, et al. Preservation

of beta-cell function and prevention of type 2 diabetes by

pharmacological treatment of insulin resistance in high-

-risk Hispanic women. Diabetes 2002; 51:2796-2803.

DeFronzo RA, Tripathy D, Dawn C, et al. Pioglitazone

for diabetes prevention in impaired glucose tolerance. N

Engl J Med 2011; 364:1104-15.

Maggard MA, Shugarman LR, Suttorp M, et al. Meta-

-Analyses: surgical treatment of obesity. Ann Intern Med

; 142: 547-59.



  • There are currently no refbacks.

Comments on this article

View all comments