Obesity has been increasing since the 1980s and has reached epidemic levels nationwide. The increasing number of obese adults and children has become a public health problem that is associated with greater morbidity and mortality and decreased quality of life. It is estimated that, by 2030, a significant portion of the adult population will be obese. Over time, obesity can lead to other health consequences, such as diabetes, heart disease, stroke, dyslipidemia, hypertension, and cancer. It is estimated that obesity contributes to a substantial number of preventable deaths annually. One obstacle to managing obesity is the difficulty of maintaining long-term weight loss. However, by engaging in regular physical activity and making informed food choices, individuals can attain and maintain a healthy weight.
Pharmacists can play a beneficial role overall on weight loss and the obesity epidemic. Regardless of the practice setting, pharmacists are in an ideal position to help patients on their journey to a healthy weight. They can provide education and information about appropriate weight-loss programs and healthy eating habits. In addition, pharmacists can determine whether a patient’s weight gain potentially may be caused by a prescription medication. Importantly, pharmacists can inquire about supplement use and discourage inappropriate use of OTC weight-loss supplements.
Goals of Weight Loss
Three main goals for people who want to lose weight are to prevent further weight gain, reduce body weight, and maintain lower body weight over time. A reasonable initial weight-loss goal is 10% of baseline body weight over a 6-month period, losing no more than 2 lb per week. Even modest weight loss can produce health benefits such as improvements in blood cholesterol and blood sugar.
Lifestyle Modification: The Cornerstone of Weight Loss
Lifestyle modifications, including a reduced-calorie diet, increased physical activity, and behavior therapy, should be the cornerstone of any weight-loss program. Lifestyle modification is crucial to the success of any weight-loss management plan. Any drug therapy for overweight and obesity should be used in conjunction with lifestyle modifications, not as monotherapy.
Diet
Reduction of calorie intake should be considered the cornerstone of any weight-loss and weight-maintenance plan. Three options are available: a 1,200 to 1,500 kcal/day diet for women or a 1,500 to 1,800 kcal/day diet for men; a diet that is 500 to 750 kcal less than the patient’s usual diet; or an evidence-based diet that restricts certain food types. Increased consumption of nutrient-poor added fats, sugar, salt, and refined grains contributes to obesity. A healthful diet should include a variety of fruits, vegetables, whole grains, and high-quality protein. Drinking more water and controlling portion sizes are two other behaviors that can promote weight loss.
Read also: Customer Experiences with Bliss
It is recommended that you reduce your fat intake to 30% of your total calorie intake whilst taking orlistat. Orlistat reduces how much fat gets absorbed from the gut. Fat that isn't absorbed comes out in poo. So, eating a high-fat diet alongside taking orlistat can worsen side-effects such as flatulence (farting), fatty or oily poo, oily spotting on underwear, increased number of bowel movements, needing to use the toilet suddenly, and loose stools.
Tips on how to reduce your fat intake:
- Change from butter or regular spreads to a low-fat spread.
- Choose lean cuts of meat and trim visible fat. Avoid skin on chicken and crackling on pork.
- Avoid added fat/oil when cooking - grill, poach, bake, or microwave instead.
- Choose low-fat dairy foods such as semi-skimmed or skimmed milk, low-calorie yoghurts, reduced-fat cheeses, and low-fat spreads.
- Choose lower-fat cook-in sauces with less than 5 g fat per 100 g sauce.
Exercise
Health-based weight loss requires a lifestyle change that includes daily physical activity. In addition to promoting weight loss, exercise can lower the risk of many disease states and aid in stress management. It is recommended to start with moderate-intensity aerobic exercise, such as walking, running, cycling, or swimming, for at least 150 minutes weekly over 3 to 5 sessions per week. The patient should increase the duration (number of minutes per session) and frequency (number of days per week) of moderate-intensity activity before increasing the intensity. Patients with a low level of physical activity should start with light activity and slowly integrate moderate-intensity activities. A higher level of physical activity-approximately 200 to 300 minutes per week-is recommended to maintain weight loss and minimize weight regain for the long term. Resistance training should also be incorporated to help promote fat loss while preserving lean mass. The key to exercise and weight loss is to be physically active daily and consistently. Activities should be individualized according to patient preference, taking into account any health-related or physical limitations.
You should also follow a program of regular physical activity or exercise while you are taking orlistat. However, before you start any new activity or exercise program, talk with your doctor or health care professional.
Behavior Therapy
For reduced-calorie diets and exercise to be successful for weight loss, the patient must adhere to these regimens, resulting in a change of lifestyle. To achieve this end, behavioral interventions should be incorporated. Such interventions may include self-monitoring of weight, food intake, and exercise; personal goal setting; education via group meetings or virtual meetings; stress reduction; motivational interviewing; counseling; and problem-solving strategies. The goal of behavior therapy is to help the patient increase his or her capacity for self-control by changing habits and maintaining the new habits.
Read also: Victoza: Dosage, side effects, and weight loss results
Orlistat: An FDA-Approved OTC Option
Drug therapy should always be used in conjunction with lifestyle changes. Orlistat provides an FDA-approved OTC option for weight loss. Patients should be educated about the importance of continued behavior modification if orlistat is added.
Orlistat (brand name: alli) is the only OTC medication that is FDA approved for weight loss in conjunction with reduced calorie intake. The OTC version of orlistat (60 mg) is indicated for overweight adults aged 18 years or older in conjunction with a reduced-calorie, low-fat diet. Prescription orlistat is used in overweight people who may also have high blood pressure, diabetes, high cholesterol, or heart disease. Orlistat is also used after weight-loss to help people keep from gaining back that weight.
How Orlistat Works
Orlistat is in a class of medications called lipase inhibitors. Orlistat does not act systemically; instead, it exerts its therapeutic activity in the lumen of the stomach and small intestine by inhibiting gastric and pancreatic lipases that hydrolyze triglycerides into free fatty acids and monoglycerides. It works by preventing some of the fat in foods eaten from being absorbed in the intestines. This restricts the intestine’s ability to absorb triglycerides, which are excreted fecally instead, thus inhibiting absorption of dietary fats by approximately 30%. This unabsorbed fat is then removed from the body in the stool.
Clinical Evidence of Orlistat's Effectiveness
In a 16-week randomized, controlled study, orlistat 60 mg resulted in significant weight loss compared with placebo (3.05 kg vs. 1.9 kg; P <.001) in mildly to moderately overweight adults. Another study evaluated the ability of orlistat 60 mg to produce a change in visceral adipose tissue in overweight patients. After 24 weeks, orlistat demonstrated a significant decrease in visceral adipose tissue versus placebo (-15.7% vs. -9.4%; P <.05). In addition, there was a trend toward a greater reduction in liver fat (which is independently linked to dyslipidemia and insulin resistance) and intermuscular adipose tissue (which is associated with metabolic abnormalities related to muscle and glucose metabolism). These findings suggest that orlistat 60 mg, along with a reduced-calorie, low-fat diet, may be an effective weight-loss tool for reducing metabolic risk factors associated with upper-body adiposity.
Studies have shown that, on average, orlistat, plus a weight-reducing diet and exercise, causes more weight loss than a weight-reducing diet and exercise alone. Some people lose 10% or more of their body weight within six months with the help of orlistat. In others, it is less effective.
Read also: Red Mountain Weight Loss: Benefits, Risks, and Results.
Dosage and Administration
Orlistat comes as a capsule and a nonprescription capsule to take by mouth. The recommended dosage of orlistat OTC is 60 mg three times per day before main meals containing between 12 and 18 g of fat or up to 1 hour afterward; the drug blocks up to 25% of fat absorption. It is usually taken three times a day with each main meal that contains fat. Take orlistat during a meal or up to 1 hour after a meal. If a meal is missed or does not have fat, you may skip your dose. If the patient skips a meal, the orlistat dose should also be skipped. Orlistat acts on each individual meal and is dependent on the types of food the patient eats and the patient’s GI transit time. In a clinical study, weight loss was observed within 2 weeks of therapy initiation and continued for 6 to 12 months.
Follow the directions on your prescription label or the package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take orlistat exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor or stated on the package.
Regardless of results, it is important for patients to continue to be physically active and maintain a healthy diet even after discontinuing orlistat. After treatment is stopped, a number of people who have lost weight with the help of orlistat put weight back on. Try to anticipate this. Once you have lost some weight, you are more likely to keep your weight down if you stick to a healthy diet, exercise regularly (if you are able) and weigh yourself once a week.
Important Considerations While Taking Orlistat
- Dietary Fat Intake: You should evenly divide the amount of daily fat, carbohydrates, and protein you eat over three main meals. If you take orlistat with a diet high in fat (a diet with more than 30% of the total daily calories from fat), or with one meal very high in fat, you are more likely to experience side effects from the medication. While you are taking orlistat, you should avoid foods that have more than 30% fat. Read the labels on all the foods you buy.
- Multivitamin Supplementation: Orlistat blocks your body's absorption of some fat-soluble vitamins and beta carotene. Therefore, when you use orlistat you should take a daily multivitamin that contains vitamins A, D, E, K, and beta-carotene. Read the label to find a multivitamin product that contains these vitamins. Take the multivitamin once a day, 2 hours before or 2 hours after taking orlistat, or take the multivitamin at bedtime. Ask your doctor or pharmacist any questions you might have about taking a multivitamin while you are taking orlistat.
- Drug Interactions: Orlistat was found to decrease serum concentrations of amiodarone, cyclosporine, levothyroxine, and antiepileptic medications. It is recommended to separate doses of orlistat from cyclosporine by 3 hours and from levothyroxine by 4 hours. Patients who are taking antiepileptic medications concurrently should be monitored closely for any changes in frequency or severity of convulsions. Because of decreased vitamin K absorption, warfarin concentrations may also be affected, resulting in an increased international normalized ratio; patients should be monitored closely when this vitamin is taken with orlistat. It is also important to tell patients with diabetes who are taking orlistat that weight loss may increase the risk of lower blood sugar and that they should watch for signs of low blood sugar, such as dizziness, headache, feeling weak or shaky, sweatiness, or a fast heartbeat.
- Contraindications: Orlistat is contraindicated in patients who are pregnant, have chronic malabsorption syndrome or cholestasis, or have known orlistat hypersensitivity.
Potential Side Effects of Orlistat
Because the absorption of orlistat is minimal, there are very few systemic effects. Common adverse effects are gastrointestinal (GI) and are caused by the increased amount of fat in the GI tract. These effects may include flatulence with discharge, fecal urgency, oily spotting, fatty or oily stool, abdominal pain or discomfort, and increased defecation. These symptoms seem to improve over time, usually lasting no longer than 4 weeks.
Some common side effects include flatulence, frequent bowel movements, soft stool, oily rectal leakage, and abdominal pain. Speak with a healthcare provider if any of these side effects become severe or troublesome. If you experience any serious side effects, such as hives, rash, skin blistering, right-sided upper stomach or abdominal pain, pain radiating toward the back, or fever, stop taking the medication and immediately contact a healthcare provider.
Rarely, severe liver injury has been reported with orlistat use, but a causal relationship has not been established. Patients should be instructed to stop taking orlistat and to speak with their healthcare provider if they develop signs and symptoms of liver injury, including itching, yellowed eyes or skin, dark urine, fever, right-upper-quadrant abdominal pain, or loss of appetite.
Who Should Not Take Orlistat?
The following people should not take orlistat:
- Pregnant or breastfeeding women.
- People under the age of 18 years.
- People who have a condition where food is not absorbed properly (a malabsorption syndrome).
- People with cholestasis. This is a condition where bile does not flow properly from the liver to the duodenum.
- People who have had an organ transplant.
Dietary Supplements: A Word of Caution
The use of dietary supplements is very common; almost 34% of people attempting to lose weight have tried a dietary weight-loss supplement. Many patients believe that these supplements are safe and effective because they are considered “natural” and are readily available in many retail settings. Some common therapies include caffeine, chromium, cinnamon, garcinia, and green tea extract.
Under the Federal Food, Drug, and Cosmetics Act, dietary supplements do not need FDA approval prior to marketing. In the past, the FDA has received many reports of harm associated with the use of weight-loss products, withdrawing many weight-loss ingredients of nonprescription products from the market, including ephedra, phenylpropanolamine, aloe, and cascara sagrada. Much of the evidence for weight-loss supplements is conflicting at best. Many of these products do not offer impressive weight-loss benefits, and most are associated with harmful side effects and interactions. Supervision is extremely important in order to protect the patient; however, many patients do not disclose or discuss weight-loss supplement use with health providers.
It is important to always consult a healthcare provider before starting any new medication or supplement.