Dr. Daz (Karoline) Harding GP in Public Health NHS Wiltshire Compliance with Orlistat Prescribing Guidelines – An Assessment Amongst Wiltshire General Practitioners Dr. Daz (Karoline) Harding GP in Public Health NHS Wiltshire

The ‘scale’ of the problem 13% of adult men 16% of adult women were obese in 1993 22% of adult men 24% of adult women were obese in 2009

The future? Foresight study (2009) By 2050 60% of males and 50% females will be obese

Orlistat NICE recommended 3 months treatment - £94.89 In 2008 total cost to the NHS was £44.8 million Tenfold rise in cost since 1998

Wiltshire costs 2009-2010 total cost of Orlistat £239,287.63 Further £76,916.10 on Sibutramine Prescribing costs vary from £0 to £5012.33

2006 NICE Obesity Guidelines Orlistat can be started ‘only after dietary, exercise and behavioural approaches have been started and evaluated’ in patients with a BMI >28kg/m2 plus co-morbidities or >30kg/m2 And continued ‘For longer than three months only if the person has lost 5% of their initial body weight since starting drug treatment, less strict in type II Diabetes’

Method Questionnaire sent to all 63 practices 39 were returned (62%) Audit of ten adult patients started on Orlistat at the ten highest prescribing practices. Nine of the ten practices participated

12% had no BMI documented before prescription 7% had a waist circumference taken 46% had no supervised period of lifestyle change 52% had no referral to weight/exercise scheme 72% had no goal weight discussed 15% achieved a 5% weight loss over 3 months 50% did not complete three months of treatment 70% of those who did not achieve 5% weight loss at 3 months were continued on the medication One in ten was not compliant Several had Orlistat on their repeat prescription list

Questionnaire 69% always trialled lifestyle change 28% always enforced a 5% weight reduction or cessation 7.5 out of 10 – difficulty rating managing obesity Hurdles and suggestions

Discussion Documentation Higher v lower prescribers Not always following guidance

Local guidance Lifestyle and Prescription contracts Lifestyle leaflets widely available with ‘Ten Top Tips for weight loss’ Physical Activity on Referral Fund independent slimming clubs on the NHS

Expected reduction in prescribing for 2011-2012 £73,244 Disseminate information amongst local GPs