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.