Long-term pharmacotherapy for obesity.

Obese patients unable to achieve significant weight loss with lifestyle changes alone may require drug therapy, and such therapy may be needed long term lest weight lost be regained. In the United States, only sibutramine and Orlistat ( Xenical ) are available for the long-term treatment of obesity. Clinical trials have shown that both drugs can induce and maintain weight loss, even in patients with comorbid conditions such as hypertension or type 2 diabetes. Their use must be combined with behavior modification and a structured meal plan, however, for patients to reap the full benefits of such treatment.

Incorrect use and limited weight reduction of Orlistat ( Xenical ) in clinical practice. A cohort study.

OBJECTIVE: To study the prescribing of the antiobesity drug Orlistat ( Xenical ) in relation to the approved indication and its weight-reducing effect in clinical practice during the first 3 months of treatment. METHODS: Anonymous postal questionnaire survey to prescribers of Orlistat ( Xenical ) concerning a random sample of 1000 of 20,000 prescriptions. PARTICIPANTS: Useful information was obtained for 789 patients. SETTING: Primary and secondary care in Sweden. MAIN OUTCOME MEASURES: Beginning and continued treatment according to the approved indication. Dropout from treatment. Weight loss during treatment. RESULTS: Four percent of the patients were prescribed Orlistat ( Xenical ) despite having a body mass index (BMI) less than 28 kg/m2. Only 24% of the patients had a diet period with a weight loss of 2.5 kg or greater before the start of therapy. Half of the patients with a weight loss of less than 5% after 3 months continued the treatment. Ten percent gained weight or had no weight loss at all while 43% lost less than 5% in weight. At least one-quarter of the patients stopped the treatment within the observation period. CONCLUSION: Orlistat ( Xenical ) was not prescribed according to the approved indication in the majority of cases. The dropout rate was high and most patients had minor gain from the treatment.

Effect of Orlistat ( Xenical ) on fat absorption in rats: a comparison of normal rats and rats with diverted bile and pancreatic juice.

Orlistat ( Xenical ) is a specific inhibitor of pancreatic and gastric lipases leading to decreased absorption of fat. In the present study, we measured the effect of Orlistat ( Xenical ) on lymphatic fat transport in rats following intake of oils very different in FA composition and TAG structure, and compared this with the transport in normal rats and rats with fat malabsorption. Rats were subjected to cannulation of the main mesenteric lymph duct, and a feeding catheter was inserted into the stomach. In addition, malabsorbing rats were cannulated in the common bile and pancreatic duct. Emulsified safflower, fish, and randomized oils were administered, and lymph was collected for 24 h and analyzed for FA composition. Administration of 25 mg Orlistat ( Xenical ) together with the dietary oils resulted in very small changes from baseline lymphatic transport, indicating that inhibition of the fat absorption was almost complete and furthermore that the source of fat had no influence on the inhibitory effect of Orlistat ( Xenical ). Orlistat ( Xenical ) did not interfere with the absorption of the hydrolysis products, since high absorption of sn-2 MAG and FFA (oleic acid) mixed with Orlistat ( Xenical ) was observed. The baseline lymphatic transport in the Orlistat ( Xenical ) group was higher than in the malabsorbing group, but this was the result of generally lower transport of endogenous FA in the malabsorbing group, presumably caused by the absence of bile FA. The transport of FA in normal rats was several-fold higher than the transport after Orlistat ( Xenical ) addition and in malabsorbing rats. Thus, this study showed that Orlistat ( Xenical ) inhibited fat hydrolysis, and thereby lymphatic absorption, almost completely independently of the fat administered.

Treatment in the community health centers in accordance with recommendations of the Medical Products Agency. Unsatisfactory weight reduction with Orlistat ( Xenical )

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 ( Xenical ) from his or her own doctor. The target weight loss of 2.5 kg prior to treatment with Orlistat ( Xenical ) 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.