AntiObesity Medication

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Anti-Obesity Medication

• NPT VTS Teaching Programme
• Bethan Yeoman

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Anti-Obesity Medication General Principles

• Should not be first-line in treatment of obesity
• Should only be used in conjunction with a healthy
  eating and good exercise programme.
• Should not be prescribed to children in General
  Practice if all other advice on behavioural
  changes, exercise and diet is failing refer to
  secondary care.

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Assessment in Adults

• Measure BMI
• Assess comorbidities DM, smoking, HTN, CVD,
  hyperlipidaemia, OA, sleep apnoea.
• Benefit in taking BP and blood for fasting glc
  and lipid profile
• NICE talk about waist circumference but actully
  minimal impact on management
• Assess diet exercise psychological stresses
  enviroment, social family factors motivation
  to change.

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General Measures

• Advice about the health implications of obesity.
• Take into account personal circumstances.
• Behavioural - goal setting, slow eating,
  modifying thoughts, assertiveness and problem
  solving.
• Exercise 30mins of at least mod. intensity on
  five or more days of the week. Build up levels.
• Diet - balanced and nutritious. 600 calory
  deficit. Reduce snacking. Programmes only if
  remain healthy (NOT Atkins).

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Anti-obesity Medication

• If BMI gt35 and other measures have been started
  and evaluated and patient not achieving target wt
  loss.
• Monitor regularly, give info on support
  programmes, discuss limitations and monitoring
  requirements.
• No license for co-prescribing of anti-obesity
  drugs.
• Orlistat (Xenical) - GI Tract
• Sibutramine (Reductil) - Central appetite
  suppressant
• Rimonabant (Acomplia) - Central appetite
  suppressant
• Rimonabant has recently been linked to a
  two-fold increase in psychiatric problems
  including suicide and the European Medicines
  Agency (and UK MHRA) has asked doctors not to
  prescribe the drug and to review all those who
  are currently taking it.

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Orlistat

• License BMI 30 or BMI 28 with associated risk
  factors.
• Lipase inhibitor reduces absorption of dietary
  fat.
• Cont after 3mths only if patient has lost at
  least 5 of body wt since starting.
• Cont for longer than 12mths only after discussing
  benefits / limitations with pt.
• Part of wt loss likely to be result of pts
  decreasing fat content of diet to avoid GI Ses
  (incl Steattorhoea).
• Vitamin supplementation (esp D) may be considered
  if concern about absorption of fat soluble
  vitamins.

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Orlistat

• Contra-indications chronic malabsorption
  syndrome, cholestasis, breast-feeding
• Cautions pregnancy
• Side Effects GI flatulence, faecal urgency
  and incontinence, oily stools, abdo pain and
  distension. Tooth and gingival disorders,
  fatigue, headache, anxiety.
• Dose 120mg during or up to an 1hr after a meal
  up to TDS. If a meal is missed or contains no fat
  omit the dose of orlistat.

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Sibutramine

• License BMI 30 or BMI 27 with associated risk
  factors.
• Inhibits re-uptake of noradrenaline and
  serotonin.
• Cont after 3mths only if patient has lost at
  least 5 of body wt since starting. Stop if wt
  loss stabilises at lt5.
• Not recommended for use beyond licensed 12mths.
• Need to monitor bp and pulse mthly for 3mths and
  then at least every 3mths. Stop if bp gt145/90 or
  if either S/D rises gt10mmHg or if pulse rises
  gt10bpm on 2 consecutive occasions.

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Sibutramine

• Contra-indications Hx of eating disorder /
  psychiatric illness, cerebro-/cardio-/peripheral-v
  ascular disease. Uncontrolled HTN. Hyperthyroid.
  Pregnancy and breast feeding.
• Cautions open-angle glaucoma, risk of raised
  ocular/pulmonary hypertension, predisposition
  to/drugs that increase bleeding.
• Side effects constipation, dry mouth,
  NV,palpitations, arrhythmias
• Dose 10mg mane, increase to 15mg if wt loss
  lt2kg after 4wks, stop if wt loss remains lt2kg
  after 4wks at 15mg.

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Rimonobant

• Cannabinoid receptor antagonist
• Contraindicated in anyone with a history of
  psychiatric illness and now linked to a possible
  increased incidence of psychiatric illness and
  suicide.
• Advised not to prescribe at present but await
  future developments.