4.5 Drugs used in the treatment of obesity

General Guidance 

For NICE Guidance on Obesity click here
 

• Obesity is associated with many health problems including cardiovascular disease, diabetes mellitus, gallstones and osteoarthritis. Factors that may aggravate obesity include depression, other psychological problems and drug treatment.
• The main treatment of obesity is a suitable diet, carefully explained to the patient, with appropriate support and encouragement; the patient should also be advised to increase physical activity. Smoking cessation (while maintaining body weight) may be useful before attempting supervised weight loss since smoking is likely to be more harmful than obesity. Attendance at groups helps some individuals.
• Drugs should NEVER be used as the sole element of treatment.
• Anti-obesity medication should only be considered for those with a body mass index of 30kg/m2 or greater in whom at least 3 months of managed care involving supervised diet, exercise and behaviour modifications fails to achieve a realistic weight reduction.
• If additional risk factors are present (e.g. established diabetes mellitus, coronary heart disease, hypertension, and obstructive sleep apnoea) then it may be appropriate to prescribe anti-obesity medication to patients with a body mass index of 28kg/m2 or greater.
• Orlistat treatment should only be considered for those individuals who have already been able to lose at least 2.5kg over a 4 week period through dieting.
• Drug treatment should be discontinued if weight loss is less than 5% after the first 12 weeks or if the individual regains weight at any time whilst receiving drug treatment.
• The primary goal of therapy should be a minimum reduction in weight of 10%.
• Any individual on a weight-reducing regimen should be monitored regularly.
• Severe obesity should be managed in an appropriate setting by staff who have been appropriately trained in its management; the patients should receive advice on diet and lifestyle modification and be monitored for changes in weight as well as blood pressure, lipids, and other associated conditions.
• Combination therapy involving more than one anti-obesity drug is contra-indicated.
• Thyroid hormones have NO place in the management of obesity unless it is associated with hypothyroidism.
• The use of diuretics, chorionic gonadotrophins, or amphetamines is not appropriate for weight reduction.

Recommended drugs

Orlistat

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low