Database of diseases - Obesity and overweight

For the first time, the European Commission has allowed OTC weight loss medicine, previously available only on medical prescription. This drug is orlistat at a dose of 60 mg. This central decision allows from January 2009 its sale under the alli trade name (producer: GlaxoSmithKline) - in all 27 Member States of the European Union, including Poland. This means that all adults who have a BMI index of 28 kg / m2 or more already have the chance to buy this drug in a pharmacy and easier to support their fight against overweight and obesity. We should also emphasize that from that moment the role and responsibility of a pharmacist as a medical adviser for a self-healing client grows immensely. 1. What therapeutic options is available from orlistat?   Clinical studies indicate that orlistat (alli) in combination with a low-calorie, low-fat diet can help lose 50 percent more weight than with diet alone. This means that for every 2 kilograms dropped by using a low-calorie, low-fat diet, taking alli, you can lose an extra kilogram. Orlistat works effectively in the digestive tract preventing absorption into the body of part of the fat contained in the food consumed and turning it into unnecessary kilograms. A leading expert in obesity, Professor Stephan Jacob of the Cardio-Metabolic Institute in Germany said: "Research has shown that consumers spend millions of euros annually on bizarre diets, unchecked" miracle pills "and potentially dangerous supplements to aid weight loss, which often do not is supported by any scientific evidence. The release of a licensed non-prescription product for sale provides consumers with the opportunity to apply proven therapy that may support their struggle with overweight. For many, dropping unnecessary kilograms can become the beginning of a process aimed at improving overall health and increasing self-esteem. " Professor dr hab. n. med. Barbara Zahorska-Markiewicz, specialist in internal medicine and public health, the President of the Polish Society for Obesity Research adds: "The prevalence of obesity is rapidly increasing reaching the scale of the epidemic. Over half of adult Poles are overweight, and 20% are already obese. Obesity is the cause of many comorbidities. This justifies taking more intensive measures to prevent and treat obesity. The introduction of a new, non-prescription form of a slimming drug facilitates weight loss and encourages obese people to take a cure. It should be emphasized that orlistat not only facilitates weight loss, but also reduces the risk of the risk factors associated with obesity - it lowers blood pressure, cholesterol and blood sugar levels. " In the context of the statements of medical authorities, stress that the program of weight loss therapy involving alli leads to healthier eating habits, as well as encourages a more active lifestyle - see below.     2. Basic principles of weight loss with orlistat at a dose of 60 mg (alli)   Mechanism of pharmacological action of the drug Orlistat 60 mg, the active substance alli, is a body weight reducing agent, due to its registered indications for overweight adults with a BMI ≥ 28 kg / m² body mass index. This active substance acts locally in the gastrointestinal tract preventing absorption of part of the fat contained in the food and converting it into unnecessary kilograms.When consumed fats are introduced into the digestive system - gastric and pancreatic lipases hydrolyze them into the form of free fatty acids and monoglycerides, which can be freely absorbed by the body. The alli therapy causes the orlistat molecules to bind to lipase molecules and deactivate them, preventing the absorption of about 25% of consumed fats. Undigested fats are excreted from the body naturally, in stool.   The recommended dose of alli is 60 mg (1 capsule) three times a day The capsule should be taken with food, immediately before or up to an hour after each main meal with water. During the day, you should not take more than three capsules of 60 mg each. If the patient does not eat a meal or if the meal does not contain fat, the dose should be skipped. Treatment should not last longer than 6 months. Patients who have not had a weight loss after 12 weeks of alli should consult a doctor or pharmacist. It may be necessary to stop the treatment. The basic principle of weight loss with the participation of alli is a low-calorie diet and physical exercise The basic principle of the therapy is combining the drug with a moderately low calorie diet with a reduced fat content. Applying alli requires reducing the amount of fat consumed to approx. 15 g / meal. While taking orlistat, the patient should remain on a nutritionally balanced, moderately low-calorie diet, in which about 30% of the calories comes from fats (eg in the diet 2000 kcal / day it corresponds to <67 g fat). The daily intake of fats, carbohydrates and proteins should be spread over three main meals. Diet and physical activity - preferably physical exercise is a very important part of the weight loss program. It is recommended to use a diet and start a physical exercise program before treatment with alli.
The diet and exercise program should also continue after the end of alli. 3. Safety of weight loss with alli support, or orlistat at a dose of 60 mg   Special groups of patients . Due to insufficient data on safety and efficacy, alli should not be used in children and adolescents under 18 years of age. Data on the use of orlistat in the elderly are limited. Orlistat has not been studied in people with liver and / or renal failure. However, due to the minimal absorption of orlistat, there is no need to adjust the dosage in the elderly and in people with liver and / or renal failure. The likelihood of adverse reactions resulting from an abnormal diet during the course of alli is approximately 30% lower than with orlistat 120 mg. Contraindications: Known hypersensitivity to orlistat or any of the excipients; simultaneous use of ciclosporin, warfarin or other oral anticoagulants; chronic malabsorption syndrome; cholestasis, pregnancy, breast-feeding. Adverse reactions associated with orlistat: Adverse reactions associated with orlistat are mainly of gastro-intestinal origin and are related to the pharmacological effect of the drug on the prevention of absorption of fat intake. Gastrointestinal adverse reactions determined on the basis of 18 months to 2 years of clinical trials of 60 mg orlistat are generally mild and transient. They occurred mostly in the early phase of treatment (within 3 months) and in the majority of patients only one-off cases were reported. Eating foods low in fat reduces the likelihood of gastrointestinal side effects. The most common stomach and intestinal disorders during therapy:   • gases (bloating) with the possibility of oily spotting, • sudden need to empty, • oily or oily stools • free stools Note: People who initially experienced side effects resulting from an incorrect diet usually learn to control them and continue to take alli. Special warnings and precautions for use of alli: Patients should be advised to follow their dietary recommendations.
If orlistat is taken with a single meal or a diet rich in fat, the likelihood of gastrointestinal symptoms may increase.The use of orlistat may potentially interfere with the absorption of fat-soluble vitamins (A, D, E and K). Therefore, it is recommended to take supplements with multivitamin supplements. In patients with diabetes - weight loss may be accompanied by improvement in metabolic parameters, therefore patients taking antidiabetic medicines should consult a doctor or pharmacist before starting alli. Dose adjustment of the antidiabetic medicine may be necessary. Losing weight can be accompanied by an improvement in blood pressure and lipid parameters
If you are taking anti-hypertensive or cholesterol-lowering medication, talk to your doctor or pharmacist since taking alli may need to adjust the dosage of these medicines. Patients who are taking amiodarone should consult a doctor or pharmacist before using alli. Isolated cases of anal bleeding have been reported with alli. patient should be advised that if bleeding from the anus should occur, seek medical advice. It is recommended that an additional method of contraception be used to prevent the contraception from weakening in the event of severe diarrhea. Editorial lapharma.infoszcz fat Bibliography: 1. Characteristics of the alli medicinal product. GlaxoSmithKline Consumer Healthcare. 2. Rossner S et al. Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years of treatment with orlistat for obesity. Obes Res 2000; 8 (1): 49-61. 3. Hauptman J et al. Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 2000; 9: 160-167. 4. Anderson J. Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage. Expert Opin Pharmacother 2007; 8 (11): 1733-1742. 5. Schwartz S et al. Compliance, behavior change, and weight loss with orlistat in an overthe-counter setting. Obesity 2008; 16 (3): 623-29. 6. Zhi J et al. Retrospective population-based analysis of the dose-response (fecal fatexcretion) relationship of orlistat in normal and obese volunteers. Clin Pharmacol Ther. 1994; 56: 82-85. 7. Fox M et al. The pathophysiology of faecal spotting in obese Subjects during treatment with orlistat. Aliment Pharmacol Ther 2004; 19: 311-21. 8. Dev V et al. Cumulative data on OTC orlistat show efficacy, not treatment effects, correlate with patient satisfaction. Obesity 2007; 15 (9): A86-274-P. (Summary) Source: GlaxoSmithKline Consumer Healthcare; More information at www.alli.pl