NICE gives rimonabant the green light

Almost two-thirds of the population of England are over-weight or obese and, according to some predictions, the current generation of children could be the first in 100 years for whom life expectancy falls. Prevention of obesity and tackling the obesity epidemic are high on the Department of Health's agenda. For treatment of obesity at the individual level, the ideal anti-obesity treatment eludes us. An effective medication that causes a sustained weight loss with minimal side effects is still lacking. Rimonabant is a recent addition to the armamentarium. It has recently been recommended by the National Institute for Health and Clinical Excellence (NICE) for use in addition to diet and exercise in obese or overweight people if orlistat or sibutramine is contraindicated, not tolerated or fails to produce adequate weight loss. It has a different mechanism of action from orlistat which is an intestinal lipase inhibitor and sibutramine which is a monoamine-reuptake inhibitor. Rimonabant is the first drug of its class to come on the market and acts by selectively blocking the endogenous cannabinoid type 1 (CB1) receptor. The endocannabinoid system plays a significant role in appetite drive and associated behaviours. Selective blockade of CB1 receptors in animal models has been shown to cause decreased appetite and reduced food intake, and also to increase energy expenditure.