This drug can help with weight loss

A diet that regularly consists of oily food is likely to cause overweight and obesity, so weight-loss efforts must comprise of dietary modifications, among other healthier behaviours. — Filepic

According to the World Health Organization (WHO), being overweight refers to an abnormal or excessive accumulation of fat within the body.

Meanwhile, obesity is characterised as a chronic, complex disease caused by excessive fat deposits that can impair health.

Obesity can significantly affect one’s quality of life and lead to physical changes.

For example, individuals who are obese may experience breathlessness, snoring, sleep apnoea, fatigue and difficulties with physical activity.

The National Health and Morbidity Survey (NHMS) conducted in 2019 revealed that 19.7% of Malaysians are diagnosed as obese, while 30.4% are overweight.

Alarmingly, almost one-third (29.8%) of the respondents between five and 13 years old faced these health conditions.

The study also revealed that overweight and obesity were prevalent among women (54.7%) and those aged 55 to 59 years old (60.9%).

A comprehensive approach is required to address obesity.

The issue needs to be tackled from several approaches, such as psychological and behavioural therapy, individualised medical nutrition therapy, physical activity interventions and the use of appropriate pharmacotherapy.

Preventive measures such as healthy eating, increased physical activity and good stress management, should also be emphasised for those at risk of obesity.

Medicine for obesity

Although pharmacotherapy is considered a possible approach to manage obesity, the decision to initiate medication for a patient should follow a comprehensive assessment.

Pharmacotherapy for obesity is only recommended for patients with a body mass index (BMI) of 30 kg/m² or more, without additional health problems, or a BMI of 27 kg/m² or more, with co-existing diseases.

Additionally, pharmacotherapy should not be used as a stand-alone treatment; it is crucial to emphasise that the medicines are adjuncts to diet, exercise and behavioural modifications.

Anti-obesity treatments should be used with supervision and careful monitoring by the doctor and pharmacist.

What is orlistat?

According to the Health Ministry’s Clinical Practice Guidelines for Management of Obesity, there are a number of medications that may be prescribed for obesity.

One of these medications is known as orlistat.

Orlistat belongs to a medicine group called lipase enzyme inhibitors, which work primarily by reducing fat absorption into the body.

Lipase enzymes play an important role in dietary fat digestion.

They work by breaking down the triglycerides (complex fat) into absorbable free fatty acids and monoglycerides (simple fats that the digestive system can absorb).

Once consumed and absorbed by the body, orlistat acts by inhibiting the lipase enzymes, preventing the breakdown of complex fats.

As a result, there will be no free fatty acids absorbed by the body.

Orlistat is the only non-systemically-acting medicine available for long-term obesity treatment.

It is categorised as a non-prescription controlled medicine, and can be purchased from a pharmacy following a consultation with a registered pharmacist.

Side effects of orlistat

The most common side effects associated with orlistat are:

• Headache
• Abdominal discomfort
• Oily and liquid stool
• Oily spotting
• Difficulty controlling bowel movement
• Diarrhoea
• Bloating
• Fatigue, and
• Anxiety.

Impaired dietary fat absorption, which leads to an increased amount of fat in the gastrointestinal tract, is the primary cause of these side effects.

With ongoing orlistat therapy, some side effects decrease and seem to improve over time, usually lasting no longer than four weeks.

Following a low-calorie and low-fat diet can help reduce the side effects.

How to take orlistat

Patients have to take orlistat three times a day, before main meals.

Taking orlistat will result in increased fat in the gastrointestinal tract, where it can cause some of the common side effects of this medication. — Shutterstock

Take it immediately before or at least one hour after each main meal.

If patients miss a meal or consume a fat-free meal, they should omit the doses.

Moreover, it is advisable for patients to take orlistat in conjunction with a low-calorie diet.

Patients should weigh their body weight prior to starting orlistat and at several intervals afterward to monitor its effectiveness.

Patients should discontinue their obesity treatment with orlistat after 12 weeks if they fail to reduce their body weight by at least 5% from the initial measurement.

Moreover, orlistat is not recommended for pregnant and lactating women.

Patients must notify the doctor or pharmacist about their pregnancy or breastfeeding status before commencing orlistat therapy.

There is a possibility that patients might experience a decrease in the absorption of fat-soluble vitamins, such as vitamin A, D, E and K, as a result of orlistat’s mechanism of action.

Therefore, it is vital for patients to take multivitamin supplements containing fat- soluble vitamins.

This is to ensure an adequate intake of essential nutrients.

Patients, however, should take the multivitamins at least two hours apart from orlistat or at bedtime.

With other medicines

Orlistat is known to lower the concentration of certain other medications, such as levothyroxine (medicine for hypothyroidism) and anti-epileptic medicines.

To ensure the effectiveness of these medicines, patients should take them separately from orlistat.

Patients taking anti-epileptic drugs require more frequent monitoring because concurrent consumption of orlistat might affect the frequency and severity of seizures.

The same issue goes for patients taking warfarin.

As orlistat might affect the concentration of vitamin K (which is required to help blood-clotting), the concentration of warfarin could increase the bleeding tendency.

In addition, orlistat consumption may reduce blood pressure and blood glucose levels.

Therefore, those on orlistat are encouraged to monitor their blood pressure and blood glucose levels.

Optimising orlistat therapy

Before starting orlistat, patients should always consult with their doctor or pharmacist to ensure that the therapy is suitable for their individual needs.

It is also advisable for those who consume orlistat to apply the 5R concept (i.e. right patient, right medicine, right dose, right route of administration, and right time of administration) at all times.

In addition, patients should keep in mind that orlistat therapy alone is not as effective as when it is taken alongside consistent behavioural modification.

Regular physical activity at least twice a week, with a balanced diet consumption, may help to enhance orlistat efficacy.

In fact, there is a possibility of gaining weight again after a patient stops taking orlistat if there is no behavioural modification.

Therefore, patients should continue doing regular exercise and eat a healthy diet to maintain their weight loss.

For any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Hazira Mohd Rosley is a pharmacist at Klinik Kesihatan Parit, Perak. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.