ABSTRACT
Obesity is one of the most visible public health problems that affect virtually all age and socio-economic groups. In 2014, WHO estimated around 2 billion overweight people around the globe, out of which 600 million (13% of the world’s adult population (11% of men and 15% of women) people are obese (WHO 2014b). In developed countries obesity has already reached pandemic proportions (In USA, 66-70% of population is overweight or obese) and in other countries it is increasing at an alarming rate based on the World Health Statistics 2012 Report, WHO (WHO 2012). In developing countries with emerging economies (classifi ed by the World Bank as lower-and middle-income countries, i.e., China, Brazil, India, and Mexico) the rate of increase in obesity has been more than that of developed countries. Many of these countries are now facing a double nutritional burden of disease. Besides problems related to under-nutrition and resultant
increase in infectious diseases, they have to deal with the rapid increase in non-communicable diseases like obesity, diabetes and hypertension (WHO 2014b). Juvenile obesity is on the rise too (Ogden et al. 2014). Children in underdeveloped and developing nations are more vulnerable to inadequate pre-natal nutrition and high intake of dense energy and low nutrient food. These dietary patterns and limited physical activity have resulted in obese but under-nourished children. In 2013, 42 million children under the age of 5 were overweight or obese. Childhood obesity is associated with a higher chance of developing life style disorders, premature death and disability in adulthood (WHO 2014a). In addition to increased risks in future, obese children experience breathing diffi culties, increased risk of fractures, hypertension, and early markers of cardiovascular disease, insulin resistance and psychological effects. The overall discouraging scenario of increase in adult and childhood obesity is linked to simultaneous increase in other non-communicable complications like cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2012; diabetes; musculoskeletal disorders (especially osteoarthritis-a highly disabling degenerative disease of the joints); some cancers (endometrial, breast, and colon). Thus, the situation requires urgent plans and strategies for the management of obesity and associated complications (Ng et al. 2014).
Continuous scientifi c efforts have been made till to date, but effective and safe pharmacological interventions for the prevention or treatment of obesity are not available. Current anti-obesity medications are pharmacological agents which can reduce or control weight by affecting one of the fundamental processes of the weight regulation in human body, i.e., altering satiety or hunger, metabolism or consumption of calories. As, these drugs alter one of physiological mechanisms of the body, they are always prone to cause many side effects (Nathan et al. 2011, Baboota et al. 2013). Alarmingly, many of these novel anti-obesity drugs have not achieved the level of clinical effectiveness required by regulatory authorities, while few that are effective that are associated with severe adverse side effects that limit their long term use. In the 1990s anti-obesity drug fen-phen (combination of fenfl uramine and phentermine) was approved by FDA. It was associated with pulmonary hypertension and heart valve problems which led to its withdrawal. Rimonabant (endocannabinoid receptor blocker) and sibutramine (catecholamine metabolism inhibitor) were also approved in the following years but withdrawn due to cardiovascular and psychological side effects. Pancreatic lipase inhibitor orlistat (approved in 1999) is also associated with multiple side effects like steatorrhoea, fecal incontinence, fl atulence and malabsorption of fat-soluble vitamins
