Obesity

Question 1

symptoms of obesity/

Answer 1

Obesity is a complex condition associated with overeating. The number of obese people in the United Kingdom has increased to record numbers. Obesity is associated with multiple long-term conditions, such as ischaemic heart disease and type 2 diabetes.
● A person is considered obese if they have a body mass index (BMI) above 30kg/m2
● Morbid obesity is the term used if a person has a BMI above 35kg/m2

Question 2

what are the red flags of obesity?

Answer 2

Patients taking:
○ Diabetes medication, as this may require adjustment
○ Antihypertensives or drugs for high cholesterol: Weight loss will aid both of these
conditions, so treatment of the conditions needs to be altered with weight loss
○ Amiodarone
○ Levothyroxine
○ Antiepileptic drugs, due to the increased risk of convulsions
● Patients that have already taken Orlistat for 6 months
● Patients that have experienced no weight loss after 12 weeks of taking Orlistat
● Rectal bleeding whilst taking Orlistat
● Kidney disease

Question 3

what are the lifestyle advice points for obesity?

Answer 3

● A mild hypocaloric diet (30% fat) combined with regular exercise without the use of Orlistat would be ideal, but if this is too difficult for patients, Orlistat may help them begin their weight loss with greater ease, increasing motivation.
● Remind women who take oral contraceptives of the need to use barrier methods of contraception whilst taking Orlistat
● Advise patients to take a multivitamin before bed, as Orlistat impairs the absorption of the fat-soluble vitamins A, D, E and K

Question 4

what is orilstat?

Answer 4

Is a potent, irreversible enzyme inhibitor. It forms covalent bonds with the serine residue of lipases in the lumen of the small intestine and stomach. Via this mechanism it causes the inhibition of the absorption of 25% of the fat from the diet

Question 5

who is orlistat licensed for?

Answer 5

Licensed for patients aged 18 years or older with a BMI of 28kg/m2 or greater to aid weight loss for a maximum of 6 months

Question 6

what is the dose regime for orilstat?

Answer 6

● One to be taken TDS with water immediately before, during or up to one hour after main
meals
○ Maximum daily dose is 180mg
○ Should not be taken with meals that contain no fat
○ Should not be taken without a main meal
○ Must be taken with a lower fat diet to lower the incidence of gastrointestinal side
effects

Question 7

what are the side effects of orilstat?

Answer 7

○ Oily leakage from rectum, faecal urgency, flatulence, steatorrheoa (the excretion of abnormal amounts of fat within the faeces)
○ Gastrointestinal side effects are more likely if the patient has a diet high in fat. It is important to remind patients that these side effects can be reduced greatly by reducing fat consumption

Question 8

when is orilstat contraindicated?

Answer 8

○ Hypersensitivity to Orlistat, or any excipients in the preparation
○ Chronic malabsorption syndrome
○ Cholestasis, where the flow of bile from the liver is blocked
○ Pregnancy
○ Breastfeeding

Question 9

what does orilstat interact with?

Answer 9

Ciclosporin: Orlistat decreases Ciclosporin levels
○ Warfarin and other oral anticoagulants: Changes in vitamin K levels may lead to
alterations of how quickly the blood clots i.e. INR (International Normalised Ratio)
○ Oral contraceptives: Orlistat may reduce the efficacy of oral contraceptives,
thereby increasing the likelihood of unwanted pregnancy.
= If patients experience diarrhoea whilst taking Orlistat with oral contraceptives, it is important to counsel them on the need to use additional methods of contraception, such as a barrier method (e.g. condoms)
○ Acarbose
○ Amiodarone: Orlistat reduces the level of amiodarone
○ Levothyroxine: Hypothyroidism may become uncontrolled with concomitant use of
Orlistat and Levothyroxine, due to lowered levels of Levothyroxine