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Background <p>Preobesity and obesity now affect over two fifths of the world’s population. Conventional state-of-the-art pharmacotherapy for weight loss (anti-obesity medication, AOM) is an integral cornerstone of international guidelines. In Asia, traditional herbal medicine is also used for this indication and is being extensively researched.</p> Objective and methodology <p>Narrative review on the use of AOM and phytopharmaceuticals in the treatment of (pre)obesity and the psychosocial lipopathic atherogenic metabolic syndrome (PSALMS).</p> Results <p>For a&#xa0;body mass index of 27 kg/m<sup>2</sup> or more, 9 AOM preparations have been approved by the European Medicines Agency (EMA) for the treatment of monogenic (orphan drugs: metreleptin, setmelanotide, somatotropin) and polygenetic/epigenetic (pre)obesity (naltrexone hydrochloride + bupropion hydrochloride, orlistat, liraglutide, semaglutide, tirzepatide). The individual AOMs have a&#xa0;wide range of effects on weight loss, with the new glucagon-like peptide 1 (GLP-1) analogues being particularly effective. In the SURMOUNT‑5 interventional study, tirzepatide 10 mg/15 mg was significantly superior to semaglutide 1.7 mg/2.4 mg (% total weight loss, TWL: −20.2% vs. −13.7%).</p> <p>Phytopharmaceuticals have also demonstrated statistically significant and clinically relevant weight loss in recent meta-analyses and interventional studies: <i>Nigella sativa</i>, <i>Camellia sinensis</i>/<i>japonica viridis</i>, <i>Coffea arabica viridis</i>, <i>Phaseolus vulgaris</i>, <i>Curcuma longa</i> and <i>Ephedra sinica</i> as well as the Japanese herbal blend bofu-tsusho-san; however, herbal medicine cannot match the success of AOM.</p> Discussion <p>State-of-the-art AOMs are highly effective appetite suppressants with managable side effects; however, they must be used continuously, as weight regain is otherwise inevitable. In the future, integrative approaches should also be pursued in multimodal treatment concepts using TCM herbs as an add-on to modern AOMs to both increase efficacy and reduce side effects.</p>

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Pharmakologische und phytotherapeutische Strategien in der integrativen Adipositastherapie

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月21日

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  • Peter Panhofer,
  • Katarzyna Krzyzanowska-Mittermayer,
  • Steffi Rothe

摘要

Background

Preobesity and obesity now affect over two fifths of the world’s population. Conventional state-of-the-art pharmacotherapy for weight loss (anti-obesity medication, AOM) is an integral cornerstone of international guidelines. In Asia, traditional herbal medicine is also used for this indication and is being extensively researched.

Objective and methodology

Narrative review on the use of AOM and phytopharmaceuticals in the treatment of (pre)obesity and the psychosocial lipopathic atherogenic metabolic syndrome (PSALMS).

Results

For a body mass index of 27 kg/m2 or more, 9 AOM preparations have been approved by the European Medicines Agency (EMA) for the treatment of monogenic (orphan drugs: metreleptin, setmelanotide, somatotropin) and polygenetic/epigenetic (pre)obesity (naltrexone hydrochloride + bupropion hydrochloride, orlistat, liraglutide, semaglutide, tirzepatide). The individual AOMs have a wide range of effects on weight loss, with the new glucagon-like peptide 1 (GLP-1) analogues being particularly effective. In the SURMOUNT‑5 interventional study, tirzepatide 10 mg/15 mg was significantly superior to semaglutide 1.7 mg/2.4 mg (% total weight loss, TWL: −20.2% vs. −13.7%).

Phytopharmaceuticals have also demonstrated statistically significant and clinically relevant weight loss in recent meta-analyses and interventional studies: Nigella sativa, Camellia sinensis/japonica viridis, Coffea arabica viridis, Phaseolus vulgaris, Curcuma longa and Ephedra sinica as well as the Japanese herbal blend bofu-tsusho-san; however, herbal medicine cannot match the success of AOM.

Discussion

State-of-the-art AOMs are highly effective appetite suppressants with managable side effects; however, they must be used continuously, as weight regain is otherwise inevitable. In the future, integrative approaches should also be pursued in multimodal treatment concepts using TCM herbs as an add-on to modern AOMs to both increase efficacy and reduce side effects.