Numerous studies have shown that the health risk associated with obesity is more closely related to visceral fat (3) than to a more peripheral fat distribution. Weight loss, independent of the therapy used, is associated with loss of visceral fat (106). As stated in Table 31.2 the ideal anti-obesity drug preferentially reduces abdominal fat mass.
Visser et al. (107) investigated the effect of fluoxe-tine on visceral fat reduction, but could not demonstrate any significant effect. In a study by Marks et al. (108) treatment with dexfenfluramine in obese type 2 diabetic subjects resulted in a selective reduction of visceral fat area, measured by magnetic resonance imaging. Meta-analysis of four long-term studies with sibutramine showed a significantly greater decrease in waist circumference, as an indicator of visceral fat mass, in sibutramine-treated subjects compared with those receiving placebo (53). The same paper reported on the preliminary data on absolute changes in visceral fat, measured by computed tomography (CT) scan, after 6 months of treatment with sibutramine, as part of the STORM trial. In these patients visceral fat decreased by 22%, which was associated with significant decreases in associated risk factors such as fasting glucose and insulin and serum triglycerides. Reduction in blood pressure was most significant in subjects with the largest visceral fat reduction (53). However, studies comparing the effect of caloric restriction with that of pharmacotherapy without caloric restriction are needed to determine the role of pharmacotherapy in reducing visceral fat (106).
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