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Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines

International Journal of Obesity volume 27, pages 103–109 (2003)Cite this article

Abstract

OBJECTIVE: To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss ≥2.5 kg during a 4 week dietary lead-in period, and weight losses of ≥5% after 12 weeks and ≥10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years.

DESIGN: A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design.

SETTING: Twenty-nine centres throughout Europe.

PARTICIPANTS: Two hundred and twenty men and women (BMI 28–43 kg/m2) who completed 2 years of treatment.

INTERVENTION: After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two.

MAIN OUTCOME MEASURES: Weight loss and obesity-related risk factor changes.

RESULTS: Weight loss ≥5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of ≥2.5 kg during the 4 week lead-in and ≥10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost ≥5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: −11.9% (95% confidence interval (CI) −13.4% to −10.3%) vs −4.7% (−5.7% to −3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved ≥5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose ≥10% body weight at 6 months compared with those who did not achieve ≥10% weight loss by month 6.

CONCLUSIONS:Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of ≥5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.

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Acknowledgements

The authors acknowledge the assistance of Bokai Xia with all of the statistical analyses. This study was supported by a research grant from F. Hoffmann-La Roche (Basel, Switzerland). KRS is employed by Hoffmann-La Roche.

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Authors and Affiliations

  1. Obesity Research Unit, Helsinki University Central Hospital, Helsinki, Finland

    A Rissanen

  2. University Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow, UK

    M Lean

  3. Obesity Unit, Huddinge Hospital, Huddinge, Sweden

    S Rössner

  4. Hoffmann-La Roche, Nutley, NJ, USA

    K R Segal

  5. O Sahlgrenska University Hospital, SOS Secretariat, Obesity Unit, Huddinge University Hospital, Huddinge, Sweden

    L Sjöström

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  1. A Rissanen
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Correspondence to A Rissanen.

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Rissanen, A., Lean, M., Rössner, S. et al. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes 27, 103–109 (2003). https://doi.org/10.1038/sj.ijo.0802165

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