Abstract
Introduction: Obesity is a chronic, complex, and heterogeneous disease that can cause more than 200 comorbidities. In the United States, more than one-third of adults (approximately 35% of men and 40% of women) are obese. It is estimated that by 2030, almost 30% of the adult population in Brazil will be obese. It is known that obesity treatment requires lifestyle changes and that drugs should be administered as a complementary alternative to treatment. Objective: Conduct a systematic review to present the main scientific and clinical evidence of anti-obesity pharmacological treatments through anorectic drugs and their associations. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from March to April 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found. A total of 30 articles were fully evaluated, and 21 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with high risk of bias and 21 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneity in their results, with X2=78.7% >50%. It was concluded that the scientific findings of randomized studies on the use of anorectic drugs to treat obesity have shown safety and efficiency in the last five years, presenting reasonable weight loss and no significant complications. The combination of naltrexone-bupropion was significantly superior to placebo. Pharmacotherapy for obesity should be conducted according to an adequate assessment of clinical evidence and personalized for each patient, considering the characteristics of each drug and comorbidities associated with obesity. Adults with binge eating disorder and obesity who responded to acute treatment with lisdexamfetamine (whether or not they received additional cognitive-behavioral therapy) had good maintenance over the subsequent 12 weeks. Maintenance with lisdexamfetamine, relative to placebo, did not provide additional benefit for binge eating, but was associated with significantly better eating disorder psychopathology outcomes and greater weight loss.