New perspectives on treatment of overweight and obesity. Review

Low physical activity, high‑calorie diet due to the formation of a positive energy balance contribute to the development of overweight and obesity and, according to forecasts, their prevalence will increase rapidly worldwide. Excess adipose tissue has negative health consequences (the greatest risks relate to visceral adipose tissue) — the development of type 2 diabetes, cardiovascular diseases, chronic kidney disease, oncology, diseases of the musculoskeletal system and negatively affects psycho‑emotional and social health. Therefore, the problem of weight loss with the subsequent normalization of metabolic processes and risk reduction is extremely relevant in such patients. But unfortunately, not all patients are able to achieve results through lifestyle changes, and this has made pharmacological and surgical methods of treating overweight and obesity more relevant. Over the past two decades, glucagon‑like peptide receptor‑1 agonists have become an important class of drugs for the treatment of obesity. They have proven a high profile of effectiveness in weight loss, but there are a number of limiting factors: achieving the so‑called «plateau effect», as well as the inconvenience of injection. Currently, the development of new glucagon‑like peptide receptor‑1 agonists and its receptors is not stopped in order to increase their effectiveness and ease of use. The first results of their clinical trials are encouraging and promising. Other pharmacological agents (affecting bitter taste receptors, blocking CB1R or restoring endogenous signaling pathways) are also being actively developed and bariatric techniques for the treatment of overweight and obesity are being improved. Special attention is being paid to new effective and safe techniques — intragastric expandable capsules and intestinal barrier implantation.