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Despite the cause of obesity being mainly due to the ingestion of foods of a high calorie content and a sedentary lifestyle, the discovery of other factors, like the alteration in the microbiota or genetic factors, have opened the possibility of new therapeutic routes.
As regards pharmacological treatment, scientific research directs its objective towards three mechanisms: reduction in the ingestion / absorption of calories; increase the energy output, and modulate the deposit of fat in the body. Drugs under investigation include Beloranib that blocks an enzyme associated with the synthesis, oxidation and transformation of fat and gastrointestinal hormones analogues such as ghrelin and amylin that block the hunger sensation.
The endoscopic treatments are minimally invasive treatments that are well tolerated and effective to achieve weight loss in the short-term. They are currently used when the patient does not wish, or is unable to choose bariatric surgery as an initial weight loss treatment in patients with a high surgical risk. Since 2016, several endoscopic devices have been approved for the treatment of obesity, such as the Orbera intra-gastric balloon and the dual balloon, with a restrictive mechanism of action, on being devices that occupy space and reduce the capacity of the stomach. The Aspire Assist consists of the aspiration of one-third of the gastric contents after each meal through a gastrostomy tube with a single port valve known as AspireAssist.
There are many candidate genes for gene therapy in obesity. Using observation data in animals deficient in leptin (a hormone released from fat tissue and that informs the hypothalamus of the energy reserves), subjects treated with physiological doses of recombinant leptin have demonstrated a successful weight loss.
Restoring the intestinal microbiota through the use of pre-biotics, probiotics, and faecal transplant are being investigated for weight loss in the treatment of obesity.