Clinical Briefs-By Louis Kuritzky, MD

Orlistat in the Long-Term Treatment of Obesity in Primary Care Settings

Obesity is a problem in about 30% of the U.S. population, but few successful long-term strategies have been identified. Recently, focus has been shifted from achievement of ideal body weight to achievement and maintenance of 5-15% reductions in body mass index (BMI), which translate into meaningful improvements in traditional cardiovascular risk factors. Most studies of pharmacotherapy for obesity have been short term, and have studied populations in non-primary-care settings. This report details a primary care setting study of obese persons (BMI ³ 30) who were treated with diet combined with orlistat 60 mg or 120 mg thrice daily for two years (n = 635).

The larger dose of orlistat produced a 7.9% decrease from initial body weight, compared with a 4.2% decline in the placebo group at the one-year mark (both groups received dietary intervention). Maintenance of weight loss was significantly better for orlistat recipients than placebo. Approximately half of orlistat-treated patients lost at least 5% of their initial body weight by one year, compared with 30.7% in the placebo group. Lipid levels and blood pressure were favorably affected by drug treatment.

Tolerance of treatment was excellent; rates of withdrawal due to adverse events were not statistically different between placebo and treatment groups. GI effects, the most frequent adverse experience, were generally transient and mild to moderate, resolving without intervention.

Orlistat is effective and well tolerated over the long term in the primary care setting.

Hauptman J, et al. Arch Fam Med 2000;9:160-167.