Impact of orlistat therapy on weight reduction in morbidly obese patients after implantation of the Swedish adjustable gastric band.

Zoss I, Piec G, Horber FF.

Hirslanden Clinic, Witellikerstr. 40, CH-8008 Zurich, Switzerland.

BACKGROUND: Adjustable gastric banding (AGB) is frequently performed to treat morbid obesity. One problem which can occasionally develop after a restrictive procedure is consumption of a high calorie liquid diet, which may prohibit further weight loss. Orlistat, a newly developed intestinal lipase inhibitor, prevents absorption of about one-third of ingested fat. It is unknown whether patients no longer losing weight after AGB, despite further band restriction, may lose weight with addition of orlistat. METHODS: 38 patients were selected who had stopped losing weight 3 months before the initiation of the study, 18 +/- 6 months (mean +/- SEM) after laparoscopic AGB. Subjects were divided into 2 groups, matched for age, sex, filling volume of the band and body mass index (BMI) both at the time of surgery and start of the study (18 +/- 6 months after AGB). RESULTS: Patients in group A received dietary counseling and orlistat 120 mg TID for 8 months, while patients in group B received only dietary counseling. During the following 8 months of study, subjects in group A lost 8 +/- 3 kg in weight, whereas subjects in group B lost 3 +/- 2 kg (p < 0.01, months 18 vs 26 of study; p < 0.03, group A vs B). In 15 patients from group A the study was further extended 9 months, but interestingly, weight remained stable independent of whether orlistat was continued (n = 8) or stopped (n = 7). 4 subjects were excluded from the extension study because of additional malabsorptive bypass surgery. Subjects taking orlistat encountered only minor GI side-effects. CONCLUSION: Orlistat appears to be useful when added in patients after AGB who are no longer losing weight, perhaps due to a high-calorie liquid diet rich in fat.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11868286&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


[Treatment in the community health centers in accordance with recommendations of the Medical Products Agency. Unsatisfactory weight reduction with orlistat]

[Article in Swedish]

Hedqvist M, Eggertsen R.

Molnlycke vardcentral.

We treated 44 individuals, 31 women and 13 men, for 12 months; each one had a body mass index > or = 28 kg/m2. Mean age was 53 years (range 20-75 years). Each individual visited a nurse regularly for diet recommendations, and each was provided a prescription for orlistat from his or her own doctor. The target weight loss of 2.5 kg prior to treatment with orlistat was obtained by 28 patients. After 3 months the average weight loss was 3.3 kg, and after 6 months, when 10 women and 6 men remained, the average weight loss was 6.1 kg and 6.5 kg respectively. The average weight decrease between 6 and 12 months was 0.3 kg and 2.7 kg for 7 women and 4 men respectively. Total cost for medical staff's working hours was approximately 700 Swedish crowns per kg weight loss. This cost seems rather high in comparison with the unsatisfactory results obtained for the group as a whole.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11881245&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


Demand, appropriateness and prescribing of 'lifestyle drugs': a consultation survey in general practice.

Ashworth M, Clement S, Wright M.

GKT Department of General Practice and Primary Care, Kings College London, 5 Lambeth Walk, London SE11 6SP, UK.

BACKGROUND: The simultaneous launch of orlistat and sildenafil in 1998 provoked much media attention, particularly around the role of lifestyle drugs and their potential costs if controls were not established. Fears were also expressed that primary care would be overwhelmed by demand, and little information was available about the attitude of GPs to their new role as prescribers of lifestlye drugs. Partly in response to these concerns, tight prescribing guidelines and licensed indications, for sildenafil and orlistat, respectively, were issued. OBJECTIVE: Our aim was to describe levels of demand for orlistat and sildenafil in general practice, whether this demand was translated into a prescription, adherence to prescribing guidelines/licensed indications and the GP perception of appropriateness of an NHS prescription for either of these drugs. METHOD: We carried out an observational study in primary care conducted over a 6-week period during 1999. Twenty-seven GPs were recruited, each from a different practice. All GP consultations were recorded for the study period and the GP completed a structured questionnaire each time sildenafil or orlistat were discussed in a consultation. RESULTS: Sildenafil was discussed in 0.5% (68/13 394) of consultations and orlistat in 0.3% (42/13 394). GPs thought that a corresponding NHS prescription would be highly appropriate in 57 and 74% of cases, respectively, although for both lifestyle drugs, nearly 20% of GPs thought such prescriptions were inappropriate. An NHS prescription was issued in 43% of consultations in which sildenafil had been discussed and 33% in which orlistat had been discussed. Five out of 29 NHS sildenafil prescriptions were issued to patients failing to fulfil the requirements of prescribing guidelines; similarly, one out of 14 orlistat prescriptions fell outside licensed indications. There were four examples of NHS prescriptions for sildenafil which were given even when the GP thought the drug to be inappropriate, whereas orlistat was never given when the GP thought it inappropriate. CONCLUSIONS: Levels of demand for the two lifestyle drugs, sildenafil and orlistat, were modest when compared with earlier media predictions. Neither was there evidence that GP was pitted against patient in their negotiation concerning a lifestyle drug NHS prescription since most GPs agreed with their patients that such a prescription was appropriate. Prescribing guidelines and licensed indications were generally adhered to, but the modest level of demand raises questions about expanding the guidelines for sildenafil.

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xenical (orlistat)


Orlistat: a second look. At best, a minor adjunct to dietary measures.

[No authors listed]

(1) Treatments for obesity are disappointing, and none has yet shown an effect on morbidity or mortality. Non drug treatments have not been assessed adequately. Long-term maintenance of weight loss requires long-term patient management. (2) Orlistat, a gastrointestinal lipase inhibitor, is licensed in Europe for the treatment of obesity, in combination with a low-calorie diet. (3) The risk-benefit ratio of orlistat could not be estimated from the initial assessment file in 1999. There were fears over a possible increase in the risk of breast cancer. (4) Few new efficacy data have been obtained since. Medium-term trials (12-24 months) show that orlistat (120 mg three times a day), combined with dietary intervention, has a minor supplementary effect on weight loss (-3.5 kg on average). (5) A meta-analysis of three of the four available comparative trials lasting two years failed to conclude that orlistat prevents the onset of type 2 diabetes. Likewise, there is no firm evidence that orlistat lowers cardiovascular morbidity or mortality. (6) Orlistat frequently has gastrointestinal adverse effects, and case reports of hypertension have been published. Orlistat probably interacts with a number of other drugs. (7) Follow-up of nearly 8,000 women for only a few years showed no increase in the incidence of breast cancer on orlistat. (8) In practice, dietary intervention and risk factor management remain the cornerstones in the management of obesity. Orlistat is only a minor, optional and temporary aid, although it appears so far to have no serious adverse effects.

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xenical (orlistat)


[Are drugs necessary in the treatment of obesity?]

[Article in Croatian]

Ivkovic-Lazar T, Stokic E, Lepsanovic L.

Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Klinicki centar, Novi Sad.

INTRODUCTION: The main principles of obesity treatment are dietetic nutrition, physical activity and psychotherapy. Drug therapy is adjuvant, time limited and can be applied only with the mentioned therapeutic measures. An ideal antiadipose agent induces a potent decrease of body mass on the account of fat depot, it can be administered for a prolonged time without developing resistance, it should not be accompanied by significant side effects, and it has no negative effects on the obesity-related diseases. ANTI-OBESITY AGENTS: Nowadays, there are mainly two groups of drugs in use, having different mechanisms of action: appetite suppressors and fat resorption inhibitors. From the first group of drugs the most suitable is dexfenfluramine, which is applied in obese nervous and tense subjects and in cases of compulsive food intake whereas fat resorption inhibitors (tetrahydrolipstatin, orlistat) are especially recommended to obese patients with accompanying hyperlipoproteinemia. Insulin-dependent form of diabetes is an indication for administration of drugs from this group. CONCLUSION: Of course, before applying drugs it is necessary to thoroughly consider indications and especially contraindications of their action. In respect to the treatment duration, three-month treatments are mainly recommended. Prolonged courses are acceptable only if well-controlled studies are in question.

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xenical (orlistat)