1. Drugs for Weight Loss 1

2. Obesity
May be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers, although underweight or normal-weight patients also suffer from these conditions 2

3. Assessment of Obesity-Related Health Risk
Assessment: obesity
Degree of obesity
Body mass index (BMI)
Pattern of fat distribution
Waist circumference
Presence of risk factors
Coronary heart disease, diabetes, hypertension
Other atherosclerotic diseases, sleep apnea 3

4. Overview of Obesity Treatment
Who might want to be treated?
Body mass index (BMI) of 30 or more
BMI of 25 to 25.9 plus two risk factors
Weight circumference (WC) greater than 40 inches (in men) or greater than 35 inches (in women) plus two risk factors
Treatment goals 4

5. Treatment Modalities Nutritious diet Exercise Behavior modification
Drug therapy
Bariatric therapy 5

6. Weight-Loss Drug
Only weight-loss drug currently approved for long-term use:
Orlistat (Xenical, Alli) 6

7. Sibutramine (Meridia)
Withdrawn in 2010 because of risk of stroke and myocardial infarction
Additional adverse effects included:
Headache
Dry mouth
Constipation
Elevated heart rate
Insomnia
Elevated blood pressure
Nervousness and anxiety 7

8. Orlistat (Xenical, Alli)
Acts in the GI tract to reduce absorption of fat
Adverse effects
GI effects
Fecal incontinence
Fecal urgency
Oily spotting
Oily stools
Can be reduced somewhat with decreased fat intake and psyllium
Reduced absorption of fat-soluble vitamins
Take vitamin supplement: 2-hour window 8

9. Orlistat (Xenical, Alli)
Cautions
Vitamin K deficiency can intensify effects of warfarin
Associated with severe liver damage
May cause hypothyroidism in patients taking levothyroxine 9

10. Miscellaneous Appetite Suppressants
Sympathomimetic amines
Nonamphetamines
Amphetamines
Bupropion
Fluoxetine
Topiramate and zonisamide 10