#1-1. History of anti-obesity drugs I

The market for obesity treatment is growing rapidly. Many aesthetic clinicians including plastic surgeons and dermatologists are applying various methods to the treatment of obesity. Dr. Yoon Jangbong of Nowbe Clinic is currently serving as the President of Korean Academy of Aesthetic Medicine and is contributing to the development of anti-obesity treatment. Dr. Yoon is a psychiatrist who believes that a balanced, comprehensive approach encompassing diet, exercise, cognitive behavioral therapy, and medication can provide the best remedy to obesity. This series will focus on medication as part of obesity treatment. Starting with the history of anti-obesity drugs, it will also cover the types and indications of these medications.

After being prescribed with obesity drugs, patients would most frequently ask how many kilograms they would lose with the drug. Anti-obesity drugs were introduced many decades ago, however, patients still have unrealistic expectations about its effect on weight loss. I have to confess that I once held the same expectations while reading a paper about a new anti-obesity drug. I wondered if the new drug brought more effective weight loss than other drugs.

This is why I decided to start this series ambitiously titled ‘Understanding Anti-Obesity Drugs.’ I would like to first briefly go over the history of anti-obesity drugs and delve into the classifications and indications. The first two articles in the series will cover the history of anti-obesity drugs. We will take a close look at the early anti-obesity medications used in the past in this article and current medications in the next article.

In the field of obesity treatment, anti-obesity drugs make a small portion of the therapeutic options available. Numerous anti-obesity drugs are being introduced and the media and society do not always hold favorable views about using medication to lose weight. Obesity, on the other hand, continues to be on the rise. It may sound even trite to say that a comprehensive approach including the diet, exercise, cognitive behavioral therapy and medication is needed for effective weight control. This may be the very essence of “diaita,” a Greek word meaning diet. Diaita refers to lifestyle habits for healthy living, i.e., balanced diet and healthy mind and body. The word diet came to be used to signify a strict dietary regimen for weight loss because of an English mortician.

William Banting (1796-1878) was a mortician 168cm tall and weighing 92kg. His BMI was 32.6kg/cm², which indicates moderate to severe obesity in today’s standards. Due to his body shape, he could not tie his own shoes, suffered auditory and visual deterioration and had to go down the stairs backward because of arthralgia. After consulting a fellow doctor William Harvey, he started a low-carbohydrate diet and experienced a weight loss of 25 kgs and improvement of obesity-related complications over 100 weeks. He published his experiences in a book titled Letter on Corpulence. After his book was published, the word ‘diet’ started being understood as ‘dietary control’ and the phrase ‘Banting diet’ is still being used. The famous Atkins diet can be seen as a modern successor of the Banting diet.

It would take a few books to discuss the famous diets out there, such as one-food diets, very low calorie diet, and protein diet, etc. However, as this series focuses on anti-obesity drugs, I will abstain from other important aspects of the obesity treatment such as diet, exercise and cognitive behavioral therapy.

In history, ancient records say Cleopatra used certain spices, herbs and honey, etc. to maintain her beauty. Records from around the 2^nd century A.D. say Soranus of Ephesus in Greece used vomit- and diarrhea-inducing drugs to lose weight. However, the beginning of modern anti-obesity medication was in the late 19^th to early 20^th century. As with all other drugs and therapies, the anti-obesity drugs were not used correctly in the beginning.