[Obesity: novel pharmacological treatments].

Obesity is currently considered as adiposity based chronic disease with BMI as therapeutic target for prevention of obesity associated complications. For treatment of obesity, a stepwise approach is recommended including multifactorial basal therapy with nutrition counseling, exercise training and behavior modification. Further steps comprise adjuvant pharmacological treatment and bariatric surgery. With the development of incretin based medications that activate GLP-1 and GIP receptors for increase in satiety, an impressive improvement in effectivity of obesity medications is observed. Licensed substances in Germany include the GLP-1 receptor agonists liraglutide and semaglutide, and the GLP-1/GIP receptor coagonist tirzepatide. Trial data reveal weight losses of on average 7.5 kg after 160 weeks for liraglutide, up to 17.4 kg after 68 weeks for semaglutide, and up to 22.5 kg after 72 weeks for tirzepatide. In addition, semaglutide demonstrated positive results in cardiovascular outcome trials. The weight reducing effects of incretin based substances are close to those achieved by bariatric interventions, therefore closing the gap between lifestyle intervention and bariatric surgery.