Patients views

1
Patients views experiences of anti-obesity
drugs
Katie Psarou Senior Lecturer, University of
Chester Dr Ian Brown Senior Lecturer, Sheffield
Hallam University Sheffield, 25th November 2008
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Background

• Obesity- a public health issue
• Available anti-obesity drugs
• Gut
• Orlistat- Xenical
• Brain
• Sibutramine- Reductil
• Rimonabant- Acomplia

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Aim and Methods

• Aim to explore obese overweight patients views
  and experiences of anti-obesity drugs
• Methods
• Patients prescribed either orlistat, sibutramine,
  rimonabant in the last 2 years
• Participants recruited from 3 GP practices
• Total of 31 participants
• Interviewed at own home/ health centre
• Research team developed interview guide
• Interviews took max 40mins

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Participants Characteristics
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Main Findings I

• Health concerns are the key factor for seeking
  weight loss medications
• I told him I were worried about me weight,
  obviously, I mean Ive had two heart attacks
  actually, Ive got arthritis, and the doctor
  forever telling me I ought to be losing weight.
• Some were motivated about body image
• I think what started it all, my friend had a
  gastric band put in she lost 7 stone and she
  started looking younger again I thought, oh God
  its my weight thats ageing me so Ill try and
  do something about my weight and - well I think
  thats what kicked it off.

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Main Findings II

• Most participants expected to lose weight but
  some had high expectations others were
  sceptical
• That they would, I suppose just support what I
  was trying to do, that it would really help, not
  be a miracle cure but help.
•  
• Well, I expected the weight loss to be more
  dramatic than it is.
• I think I was a bit sceptical, they dont help.

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Main Findings III

• Those on orlistat understood how it works but
  those on sibutramine/ rimonabant were unsure
• Well, I think that were only if Id eaten like
  too much fat, you know. It just came out like,
  it was like somebody had dropped a drop of oil in
  toilet. But I presume thats what they were
  there to doStops your body absorbing fat so its
  got to come out somewhere, hasnt it?
• But I never felt that sibutramine made me
  feel full ... But these have been, I just dont
  know, I didnt know how theyve worked but they
  have worked.

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Main Findings IV

• Participants who could observe successful weight
  loss in the short-term adapted to medication
  regime managed side effects
• Not eating too much fat, basically. Its just
  a balanced diet. As you will know, what they
  suggest, they said get a plate, cut it in half,
  one half vegetables etc...and two of the quarters
  there, one meat and one carbohydrate...
• Those unsure of medication effectiveness or with
  high expectations were more likely to experiment
  with regime
• sometimes I took two of them orlistat and
  its not made no difference.

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Main Findings V

• Majority of participants suggested ways to
  improve health service support.
• Id just like to think that people are getting
  the understanding and, you know, they know whats
  expected from the tablets and they know whats
  expected from them.
• to help people even further it would be better
  if there was some kind of group maybe outside the
  doctors or maybe, I dont know, in a health
  centre or somewhere where they could go to for
  that additional support and meet other people
  that was struggling as well.

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Implications for Practitioners I

• Initial Assessment clarify patients perceptions
  of their obesity, reasons for seeking medical
  help expectations of anti-obesity drugs
• Information Provision ensure clear understanding
  of medications mode of action, side effects,
  dose/regime, duration associated lifestyle
  changes
• Quality of Ongoing Support provide fup appts
  for monitoring addressing difficulties, suggest
  other avenues for support (nurse, dietitian,
  group therapy, exercise on prescription)

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Implications for Practitioners II

• Transitions in Coming Off Medication be aware of
  patients weight concerns after discontinuation
  of medication guide patients to suitable
  alternative support
• Attitudes address attitudes of primary care
  staff, if necessary, to improve patients
  perceptions about negative attitudes associated
  with obesity stereotypes

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Thank You

• Acknowledgements
• Sheffield Health Social Research Consortium for
  funding support
• Study participants for taking part
• GP practices for helping us recruit
• Lay representatives
• Email k.psarou_at_chester.ac.uk