Orlistat can only be prescribed as part of an overall plan for managing a person’s weight in adults who have a BMI of 28 kg/m2 or more with an obesity-linked disease or in a person with a BMI of 30 kg/m2 or more.
Orlistat treatment can only be considered for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes.
After taking orlistat for 3 months, you can only continue to have this prescribed if you lose at least 5% of your starting body weight unless you have type 2 diabetes in which case your health care provider may decide upon a lower target.
Fats from foods need to be broken down by enzymes called lipases to be absorbed into the body. These enzymes work in the gut.
When orlistat is taken with meals, it prevents these enzymes from working and causes a decrease in the amount of fat your body absorbs from your food.
If you eat fatty foods whilst taking orlistat this may cause flatulence and diarrhoea, which will discourage you from eating food that contains fat. Studies with orlistat have also shown that it may also improve other health factors beyond weight, including waist circumference, blood sugar, blood pressure and cholesterol levels.
You cannot take orlistat if you have gall bladder disease or are pregnant or breastfeeding.
Liraglutide 3 mg
Approved for use in the NHS for people who meet the following criteria:
Liraglutide 3mg is recommended as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults, only if the individual fulfills all of the following 4 points:
- Have a body mass index (BMI) of at least 35 kg/m2(or at least 32.5 kg/m2for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population)
- Have pre-diabetes but not type 2 diabetes.*
- Have a high risk of cardiovascular disease based on risk factors such as high blood pressure or abnormal blood lipids
- It is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service
*Pre-diabetes is diagnosed by having blood tests and there are two tests
- Haemoglobin A1c level (HbA1c) of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%]
- Fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre
If after 12 weeks of the 3mg dose a person has not lost 5% or more of their initial weight then the drug must be stopped.
Liraglutide 3mg once daily subcutaneous injection is available privately for adults with:
BMI of 27 kg/m2 or more with an obesity-linked disease or have a BMI of 30 kg/m2 or more as part of an overall plan for managing a person’s weight.
People should not take liraglutide 3mg if they have a personal of family history of medullary thyroid cancer or multiple endocrine neoplasia or if they are pregnant or planning pregnancy or breastfeeding.
The dose of liraglutide injected is gradually increased over a 4-week period to reduce gastrointestinal side effects. If after 12 weeks of the 3mg dose, a person has not lost 5% or more of their initial weight then the drug must be stopped.
Liraglutide is a synthetic version of glucagon-like peptide-1 (GLP-1), a hormone that is found naturally in your body that effects appetite and food intake. Liraglutide 3mg is thought to help people lose weight loss by decreasing appetite and reducing the amount of food that they eat.
Liraglutide 3mg treatment can only be considered for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes. Liraglutide comes in a prefilled pen that you can use to self-inject.
Studies have shown that Liraglutide 3mg may also improve other health factors beyond weight, including waist circumference, blood sugar and blood cholesterol levels. Liraglutide at the lower doses 0.6 mg, 1.2 mg and 1.8 mg is available on the NHS for helping to lower blood sugar in people with T2D but these lower doses cannot be used in people without T2D.
Naltrexone/Bupropion (8 mg/90 mg)
Naltrexone/Bupropion (Mysimba) is available by private prescription in the UK. Naltrexone/Bupropion can only be prescribed as an adjunct to a reduced calorie diet and increased physical activity in adults who have a BMI of 27 kg/m2 or more with an obesity-linked disease or have a BMI of 30 kg/m2 or more.
Treatment with Mysimba must be discontinued if a person has not lost 5% of their initial body weight or more after 16 weeks.
Mysimba cannot be prescribed to people with uncontrolled high blood pressure, a history of seizures, with a known brain tumour, a history of bipolar disorder, undergoing acute alcohol of benzodiazepine withdrawal, a previous history of bulimia and anorexia nervosa, patients who are dependent upon opioids or receiving monoamine oxidase inhibitors.
Mysimba is thought to reduce appetite by acting on the part of the brain that controls hunger. Studies have shown that Mysimba may also improve other health factors beyond weight including lower blood sugar.