Is it for me?

Drug therapy may be helpful for some obese patients, especially when used in combination with diet, exercise and behaviour modification. The decision to start drug therapy should be made with your doctor only after careful evaluation of the risks and benefits.

Anti-obesity drugs should only be considered if 3 months of managed care, involving supervised diet, activity and behaviour modification fails to achieve a realistic reduction in weight in those who:

• Are obese (a BMI of 30 kg m² or greater); OR;
• Are overweight (a BMI of between 27 and 30 kg m²) and who have other medical problems such as diabetes, coronary heart disease, high cholesterol, high blood pressure or obstructive sleep apnoea that further increase their risk of heart disease.

To calculate your own BMI, use our BMI Calculator.

It is important that each individual undergoing drug therapy is monitored regularly. Drug therapy should be discontinued if weight loss is less than 5% after 3 months or if the individual regains weight at any time whilst receiving drug treatment.

What Drugs are Available?

The main drugs available for treating obesity are:

• Xenical (Orlistat)
• Reductil (Sibutramine)

Details of these drugs are shown below and give an overview of dosage, risks, etc. As with all treatments, it's very important that you discussion the options with your doctor before making any decisions. However, if you would like any further information on either of these drugs, do contact us and we'll be happy to help.

Xenical

Orlistat (Xenical) is a drug that reduces the absorption of dietary fat and helps some obese patients lose weight. NICE (National Institute for Clinical Excellence) have recommended that treatment with Orlistat should only be continued beyond 6 months if at least 10% weight has been lost since the beginning of treatment.

Some of the (positive and negative) effects of Orlistat are:

• cholesterol levels often improve
• In diabetics, Orlistat can help blood sugar control
• Blood pressure sometimes falls
• Stomach cramps, wind, oily leakage from the rectum, liquid or oily stools, faecal incontinence and diarrhoea - however these symptoms are usually mild and get better after the first few weeks of treatment.

Reductil

Sibutramine (Reductil) is an appetite suppressant that is effective for some people. The recommended starting dose is 10mg daily in the morning, increased to 15 gm daily if weight loss is less than 2 kg after 4 weeks. It should be discontinued if weight loss is less than 2 kg after 4 weeks at the higher dose and it should be discontinued if weight loss after 3 months is less than 5% of initial body weight, weight loss stabilises at less than 5% of initial body weight or individuals regain 3 kg or more.

With use of Sibutramine, insomnia, 'dry mouth', and constipation can occur. Also, increases in blood pressure can occur so you need to be carefully monitored by your doctor especially if you are taking drugs that increase blood pressure.

Your blood pressure and pulse should be checked every 2 weeks for the first 3 months and then monthly for 3 months and then at least every 3 months. Sibutramine should be stopped if your blood pressure exceeds 145/90, if the systolic or diastolic pressure rise by more than 10 mmHg or if the pulse rate increases by 10 beats per minute at 2 consecutive visits;

Sibutramine should not be given to people with a history of heart disease or stroke, though it is worth noting that to date there is no evidence that the drug causes heart valve abnormalities or pulmonary hypertension as reported with Fenfluramine.