The National Institute for Clinical excellence (NICE) and the National Obesity Forum (NOF) both recommend pharmacotherapy (obesity drugs such as lipase inhibitors) to help with weight loss where appropriate. This includes patients who either:

• Have not been successful with a weight management programme based around lifestyle, exercise or nutrition advice

• Are considered at such a high risk for the co-morbidities of obesity that they need to lose weight more rapidly than by traditional methods alone

The following obesity medications are available:

Orlistat

Orlistat is part of a group of obesity drugs called lipase inhibitors. It works by reducing the amount of fat that is absorbed into the body.  (“Lipase” means fat) 1/3 of the fat consumed by food is not absorbed and turned into calories whilst taking this obesity medication.

If a patient has a stable weight prior to taking obesity drugs such as Orlistat then using this obesity medication will allow them to lose weight.

However, if a patient taking Orlistat eats a diet high in fat then they will experience side effects, including yellow diarrhea; painful flatulence; oily stools; and in extreme cases faecal incontinence. These side effects are not from the obesity medication but from the high-fat diet. For this reason, patients need to be counselled by a healthcare professional to eat a low fat diet, reducing the risk of side effects with Orlistat and other lipase inhibitors.

A recent European licence has been granted for a lower dose of 60mg of Orlistat available over the counter from the pharmacist. However, this obesity medication is not available to simply pick up and purchase. There will still be a structured weight management programme put in place, which will be managed by the pharmacist.

The advantage for the patient is that they do not have to visit their GP to get a weight reducing drug. It is the first time that an obesity medication will be available over the counter in the UK.

Sibrutramine

Sibrutramine , also known as Reductil, is an alternative weight reducing drug. Sibrutramine acts centrally on parts of the brain to make the patient feel fuller. During the first few weeks of taking this obesity medication there is a risk that a patient’s blood pressure can rise, which is why a GP will want to see any patient taking sibrutamine on fortnightly visits to check their blood pressure remains within normal limits whilst taking the obesity medication.

Warning: The European Medicines Agency has recommended that sales of sibutramine be suspended due to links to an increased risk of cardiovascular events. Read more.

Dr Matthew Capehorn, Obesity Specialist
Chairman of the Yorkshire and the Humber region of the National Obesity Forum

10045 November 2011