Medical / pharmacotherapy treatment

 

Our medical treatment arm is led Dr Carel Le Roux, a world expert in the field of obesity.

 

Medications for obesity help people lose weight decreasing their overall calorie intake. They work best when used regularly and in conjunction with daily exercise and a reduced calorie meal. There are mainly two classes of drugs: those that act on the gut and decrease the absorption of fat in the diet, and those that act on the brain and reduce the sensation of hunger.

 

It is recommended that these medications are prescribed to patients who have a BMI of greater than 30, with no other medical conditions, or those who have a BMI greater than 27 and one or more other medical conditions, such as heart disease or diabetes. It may also be prescribed to more overweight patients who are awaiting surgery, not suited or unwilling for surgery.

 

All these medications can only be taken after consultation with Dr Le Roux. Before starting any of these medications, the prescribing doctor must be made aware of all other current illnesses and medications. None of these medications are currently licensed for use with pregnant women or breastfeeding mothers. It is best not to drink alcohol while taking these medications as alcoholic drinks such as beer, cider, wine or spirits are high in calories and are a common cause of weight gain.

 

The three anti-obesity drugs currently available for prescription in the UK are:

 


Orlistat (Xenecal)

The fat in the diet is digested in the body into its simplest form so that it can be absorbed. The body does this with the help of enzymes called lipases. The excess fat or calories in the diet is thus absorbed by the body and stored as body fat, resulting in weight gain.

 

When taken with meals (120mg with each meal), Orlistat attaches itself to the lipases and blocks their action. This stops some of the fat in the diet from being digested (roughly 30% of the fat in the diet). The undigested fat cannot be absorbed and is eliminated in bowel movements. This decreases the overall number of calories absorbed by the body, resulting in weight loss.

 

Using Orlistat for three to six months can result in a 5%-10% weight loss. Orlistat is a safe drug with relatively few side effects. Since it acts mainly by decreasing the absorption of fat, some people may experience changes in bowel habits. These may include diarrhoea, an urgent need to use the toilet, oily discharge and wind. These symptoms usually settle down a few weeks after treatment, and they can be significantly reduced or eliminated by adhering to a low fat diet.

 

Orlistat may interfere with the absorption of some fat-soluble vitamins. A daily vitamin supplement containing vitamins A, D, E and K is, therefore, recommended for all those using Orlistat. It is advisable to take these at least two hours before or after taking Orlistat.

 

Patients taking Cyclosporin must also ensure that Orlistat and Cyclosporin are taken at least two hours apart, and their levels may need to be monitored more frequently.

 

People with gallbladder problems or chronic malabsorption are advised not to take Orlistat.

 

Further information

Xenical

 


Sibutramine (Reductil/Meridia)

The part of the brain that controls the chemical signals that influence hunger and appetite is called the hypothalamus. Sibutramine (sold as Reductil or Meridia in the US) acts on these hormones and suppresses hunger and appetite. This helps to reduce the total, which in turn results in weight loss.

 

Sibutramine is available as a capsule and is taken in once daily 10 mg doses with or without food. The dose may be increased to 15mg per day as long as the patient had no adverse effects with 10mg. It is currently approved for treatment for one year only. If a dose is accidently missed, the next dose must be taken as usual. A double dose to make up for the missed dose must not be taken.

 

Taking Subutramine for 1-3 months reduces weight by at least 2 kgs and 5% respectively. Some of the side-effects associated with Sibutramine are constipation, nausea, a dry mouth, difficulty sleeping, feeling or being sick, a fast or fluttering heart beat, light-headedness, pins and needles, headaches, anxiety, sweating, diarrhoea, mood change, sexual problems, skin rash, problems with menstrual periods, problems with taste or blurred vision. A number of these effects improve with time.

 

Sibutramine is contraindicated in people with a history of heart disease, strokes and uncontrolled hypertension, psychiatric illness and major eating disorders. It must be used with caution in sufferers of hypertension, epilepsy and sleep apnoea. It may also interact with a number of other drugs.

 

It is advised that all patients on Sibutramine have their blood pressure checked every two weeks for the first three months of usage, and quarterly thereafter. Sibutramine may have to be discontinued if on two consecutive checks, either the BP rises above 145/90mmHg, or increases 10mmHg above baseline, or if the pulse rises by 10 beats per minute.

 

Sibutramine may very rarely cause pulmonary hypertension. Therefore any history of increased difficulty in breathing, chest pains or ankle swelling should be reported to the doctor immediately.

 

Further information

Subutrimane

 


Rimonabant (Acomplia)

Rimonabant, like Sibutramine, is a centrally acting drug. It is cannabinoid one (CB1) receptor blocker and acts on the CB1 receptors. The CB1 receptors are found in the hypothalamus and are involved in controlling our intake of highly palatable, sweet or fatty foods. Overactivation of the CB1 receptors is associated with increased appetite, cravings for food and fat build-up. Rimonabant blocks CB1 receptors and thus reduces cravings for these types of foods and helps control hunger and decrease appetite. This again helps decrease the overall calorie intake and results in weight loss.

 

Further, Rimonabant seems to have other beneficial effects including improving diabetes control and lowering cholesterol. It has also been shown to help people give up smoking.

 

Rimonabant is taken as a single daily dose of 20mg. It is approved for use in the EU but does not have FDA approval for use in the US. Adverse effects include nausea, headache, fatigue and dizziness. It has also been found to have psychiatric adverse effects including depression, anxiety, agitation and sleep disorders. It is contraindicated in people with active psychiatric illnesses. It may increase the risk of suicide and is not recommended for treatment in combination with antidepressants.

 

Further information

Rimonabant

 


 

All our above services are co-ordinated by our nurse specialist co-ordinator.

 

The cost of the medical treatment arm is between £900-£1,200 for the six-month course. The cost of medications is additional.

 

To compare costs to other treatment options, go to Plans.