CREDITS
By Dr Melane van Zyl
Patients often ask for a prescription to help them loose weight. Psychiatric medications also are often to blame for weight gain.
I have found this advice from the NHS’ (UK) website. There are other medications available for weight loss, but I agree with the NHS that these are probable the safest and most effective options. Saxenda as well as Orlistat is available in South Africa.
Medicine
Many different types of anti-obesity medicines have been tested in clinical trials, but the only ones that have proved to be safe and effective for use on the NHS are orlistat and liraglutide.
Orlistat
You can only use orlistat if a doctor or pharmacist thinks it’s the right medicine for you. Orlistat is available on prescription from your doctor, or you can buy it at a lower dose from a pharmacy. Products available directly from pharmacies are Alli and Orlos, which must be taken under the supervision of a pharmacist.
Orlistat works by preventing around a third of the fat from the food you eat being absorbed. The undigested fat is not absorbed into your body and is passed out with your poo. This will help you avoid gaining weight, and may help you to lose weight.
You’ll need to start eating a balanced diet and exercising regularly before beginning treatment with orlistat, and continue this during treatment and after you stop taking orlistat.
When orlistat should be used
Orlistat will usually only be recommended if you’ve made a significant effort to lose weight through diet, exercise or changing your lifestyle.
Even then, orlistat is only prescribed if you have either:
a body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes
a BMI of 30 or more
Orlistat is not usually recommended for pregnant or breastfeeding women.
Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects.
Follow your doctor’s advice about how to take it, and the instructions that come with your medicine.
How long to take it for
Treatment with orlistat should only continue beyond 3 months if you’ve lost 5% of your body weight. It usually starts to affect how you digest fat within 1 to 2 days.
If you have not lost weight after taking orlistat for 3 months, it’s unlikely to be an effective treatment for you. Ask your doctor or pharmacist, as you may need to stop your treatment.
Orlistat and other health conditions
If you’re taking medicine for another serious health condition, such as type 2 diabetes, high blood pressure or kidney disease, it may be necessary to change the dose of your medicine. Speak to your GP before starting treatment with orlistat.
If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after 3 months may be slightly lower.
- Side effects of orlistat
Common side effects of orlistat include:
fatty or oily poo - needing the toilet to poo urgently
- pooing more frequently
- an oily discharge from your rectum (you may have oily spots on your underwear)
- farting (flatulence)
- You’re much less likely to get these side effects if you stick to a low-fat diet.
- If you’re taking the oral contraceptive pill and you have severe diarrhoea while taking orlistat, use an additional method of contraception, such as a condom. This is because your body may not absorb the contraceptive pill if you have diarrhoea, so it may not be effective. Check the pill packet for advice.
Liraglutide
- Liraglutide (also called Saxenda) is a weight loss medicine that works by making you feel fuller and less hungry. It’s taken as an injection once a day. Your doctor or nurse will show you how to take it.
You can usually only take liraglutide if it’s prescribed for you by a specialist weight management service. A doctor might recommend that you take it if:
diet and exercise changes have not worked on their own - orlistat has not worked or you cannot take it
- you do not want to have weight loss surgery
You’ll need to eat a balanced, reduced-calorie diet and exercise regularly while taking liraglutide.
Before prescribing liraglutide, your doctor will talk you through its benefits and limitations, including any side effects you might get.
- When liraglutide should be used
Liraglutide is suitable for adults aged up to 75. It is not recommended if you’re pregnant or breastfeeding or have certain health conditions, such as liver or kidney problems.
You’ll only be prescribed liraglutide if all of these apply:
you have a BMI of 35 or more, or you have a BMI of 32.5 or more and you’re of south Asian, Chinese, black African or African-Caribbean origin - you have non-diabetic hyperglycaemia (high blood sugar)
- you’re at high risk of heart problems such as heart attacks and strokes, for example because you have high blood pressure (hypertension) or high cholesterol
How long to take it for
You’ll have a review after taking liraglutide for 3 months. You’ll then only carry on taking it if you’ve lost at least 5% of your body weight.
Surgery
- Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese.
Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria:
they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure - all appropriate non-surgical measures have been tried, but the person hasn’t achieved or maintained adequate, clinically beneficial weight loss
- the person is fit enough to have anaesthesia and surgery
- the person has been receiving, or will receive, intensive management as part of their treatment
- the person commits to the need for long-term follow-up
- Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes.
In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person’s BMI is 50 or above.