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      Use of Fluoxetine to Reduce Weight in Adults with Overweight or Obesity: Abridged Republication of the Cochrane Systematic Review

      systematic-review

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          Abstract

          Introduction

          Using fluoxetine is one of many weight loss strategies. A serotonin reuptake inhibitor indicated for depression believed to impact weight control by changing an individual's appetite; however, its benefit-risk ratio is unclear. The aim of this review was to assess the efficacy and safety of fluoxetine in reducing weight in adults with overweight or obesity.

          Methods

          We searched Cochrane Library, MEDLINE, Embase, and other databases without language restrictions. Cochrane Collaboration tool and GRADE instrument assessed the risk of bias of randomized controlled trials and certainty of their evidence. We conducted random-effects meta-analyses and calculated the risk ratio/mean difference with 95% confidence intervals for the outcomes.

          Results

          We included 19 trials (2,216 adults) and found that fluoxetine may reduce weight by −2.7 kg (95% CI −4 to −1.4; p < 0.001) and body mass index by −1.1 kg/m 2 (95% CI −3.7 to 1.4), compared with placebo; however, it would cause approximately twice as many adverse events, such as dizziness, drowsiness, fatigue, insomnia, or nausea.

          Conclusions

          Although low-certainty evidence suggests that off-label fluoxetine may reduce weight, high-certainty research is needed to be conducted in the future to determine its effects exclusively as well as whether it is useful when combined with other agents. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews 2019, Issue 10, DOI: 10.1002/14651858.CD011688.pub2. Cochrane Reviews are regularly updated as new evidence emerges, and in response to feedback, it should be consulted for the most recent version of the review.

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          Most cited references69

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          Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies.

          Association between obesity and depression has repeatedly been established. For treatment and prevention purposes, it is important to acquire more insight into their longitudinal interaction. To conduct a systematic review and meta-analysis on the longitudinal relationship between depression, overweight, and obesity and to identify possible influencing factors. Studies were found using PubMed, PsycINFO, and EMBASE databases and selected on several criteria. Studies examining the longitudinal bidirectional relation between depression and overweight (body mass index 25-29.99) or obesity (body mass index > or =30) were selected. Unadjusted and adjusted odds ratios (ORs) were extracted or provided by the authors. Overall, unadjusted ORs were calculated and subgroup analyses were performed for the 15 included studies (N = 58 745) to estimate the effect of possible moderators (sex, age, depression severity). Obesity at baseline increased the risk of onset of depression at follow-up (unadjusted OR, 1.55; 95% confidence interval [CI], 1.22-1.98; P or =60 years) but not among younger persons (aged <20 years). Baseline depression (symptoms and disorder) was not predictive of overweight over time. However, depression increased the odds for developing obesity (OR, 1.58; 95% CI, 1.33-1.87; P < .001). Subgroup analyses did not reveal specific moderators of the association. This meta-analysis confirms a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression, most pronounced among Americans and for clinically diagnosed depression. In addition, depression was found to be predictive of developing obesity.
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            Global burden of obesity in 2005 and projections to 2030.

            To estimate the overall prevalence and absolute burden of overweight and obesity in the world and in various regions in 2005 and to project the global burden in 2030. Pooling analysis. We identified sex- and age-specific prevalence of overweight and obesity in representative population samples from 106 countries, which cover approximately 88% of the world population, using MEDLINE and other computerized databases, supplemented by a manual search of references from retrieved articles. Sex- and age-specific prevalence of overweight and obesity were applied to the 2005 population to estimate the numbers of overweight and obese individuals in each country, each world region and the entire world. In addition, the prevalence, with and without adjusting for secular trends, were applied to the 2030 population projections to forecast the number of overweight and obese individuals in 2030. Overall, 23.2% (95% confidence interval 22.8-23.5%) of the world's adult population in 2005 was overweight (24.0% in men (23.4-24.5%) and 22.4% in women (21.9-22.9%)), and 9.8% (9.6-10.0%) was obese (7.7% in men (7.4-7.9%) and 11.9% in women (11.6-12.2%)). The estimated total numbers of overweight and obese adults in 2005 were 937 million (922-951 million) and 396 million (388-405 million), respectively. By 2030, the respective number of overweight and obese adults was projected to be 1.35 billion and 573 million individuals without adjusting for secular trends. If recent secular trends continue unabated, the absolute numbers were projected to total 2.16 billion overweight and 1.12 billion obese individuals. Overweight and obesity are important clinical and public health burdens worldwide. National programs for the prevention and treatment of overweight, obesity and related comorbidities and mortalities should be a public health priority.
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              Long-term drug treatment for obesity: a systematic and clinical review.

              Thirty-six percent of US adults are obese, and many cannot lose sufficient weight to improve health with lifestyle interventions alone. To conduct a systematic review of medications currently approved in the United States for obesity treatment in adults. We also discuss off-label use of medications studied for obesity and provide considerations for obesity medication use in clinical practice. A PubMed search from inception through September 2013 was performed to find meta-analyses, systematic reviews, and randomized, placebo-controlled trials for currently approved obesity medications lasting at least 1 year that had a primary or secondary outcome of body weight change, included at least 50 participants per group, reported at least 50% retention, and reported results on an intention-to-treat basis. Studies of medications approved for other purposes but tested for obesity treatment were also reviewed. Obesity medications approved for long-term use, when prescribed with lifestyle interventions, produce additional weight loss relative to placebo ranging from approximately 3% of initial weight for orlistat and lorcaserin to 9% for top-dose (15/92 mg) phentermine plus topiramate-extended release at 1 year. The proportion of patients achieving clinically meaningful (at least 5%) weight loss ranges from 37% to 47% for lorcaserin, 35% to 73% for orlistat, and 67% to 70% for top-dose phentermine plus topiramate-extended release. All 3 medications produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality. Most prescriptions are for noradrenergic medications, despite their approval only for short-term use and limited data for their long-term safety and efficacy. Medications approved for long-term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically meaningful 1-year weight loss relative to placebo. By discontinuing medication in patients who do not respond with weight loss of at least 5%, clinicians can decrease their patients' exposure to the risks and costs of drug treatment when there is little prospect of long-term benefit.
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                Author and article information

                Journal
                Obes Facts
                Obes Facts
                OFA
                Obesity Facts
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1662-4025
                1662-4033
                August 2022
                2 June 2022
                2 June 2022
                : 15
                : 4
                : 473-486
                Affiliations
                [1] aClinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
                [2] bMethodology Research Unit, Instituto Nacional de Pediatría, Mexico City, Mexico
                [3] cNutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
                [4] dIndependent Author, Mexico City, Mexico
                Author notes
                *Alejandro G. González-Garay, pegasso100@ 123456gmail.com
                Article
                ofa-0015-0473
                10.1159/000524995
                9421708
                35654016
                719b44d6-467b-47a3-93ea-d595d021c7a9
                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 6 January 2022
                : 4 May 2022
                : 2022
                Page count
                Figures: 5, Tables: 3, References: 72, Pages: 14
                Categories
                Systematic Review

                fluoxetine,weight loss,adverse events,obesity
                fluoxetine, weight loss, adverse events, obesity

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