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Orlistat for weight loss maintenance

After patients have lost weight, can long-term orlistat help them keep it off?

After patients have lost weight, can long-term orlistat help them keep it off?

Synopsis

Scandinavian researchers conducting this study began by enrolling obese patients (50% female) with a mean body mass index of 37.5kg/m2 to follow a very low calorie diet (600-800kcal/day) for eight weeks.

The patients weighed between 75kg and 162kg and also had one or more cardiac risk factors. The 309 patients who lost at least 5% of their body weight, an average 14.4kg, were randomised, using concealed allocation, to receive either placebo or orlistat 120mg three times daily for the following three years.

All patients also received continuous lifestyle counselling and were asked to follow a diet consisting of approximately 30% fat. The mean weight regain over the three years was an average 4.6kg in the treated group as compared with 7.0kg in the patients receiving placebo (P<.02).

In other words, orlistat patients weighed an average 9.4kg less and placebo patients weighed an average 7.2kg less after three years. The maintenance of weight loss was better in women than in men.

New cases of diabetes occurred in eight of the 154 orlistat-treated patients over the three years compared with 17 of the 156 patients treated with placebo (P=.041; number needed to treat = 18).

Prevention of diabetes has been shown with orlistat in other studies (Gillies CL. BMJ 2007;334:229-307).

Level of evidence

1b (see www.infopoems.com/concept/ebm_ loe.cfm)

Reference

Richelsen B et al. Effect of orlistat on weight regain and cardiovascular risk factors following a very-low-energy diet in abdominally obese patients. Diabetes Care 2007;30:27-32.

Bottom line: In highly motivated obese people who lost at least 5% of their body weight on a very-low-calorie diet, continuous orlistat treatment for three years allowed them to keep off more weight than those treated with placebo.

The numbers were not striking; treated patients regained an average 2.2kg less than placebo-treated patients after three years.

There was also less incidence of new diabetes diagnoses in the treated patients, which echoes results found in other studies.

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