20th February 2024

Medical therapies

Medical therapies for weight loss should only be considered in conjunction with the lifestyle advice highlighted above. Treatments that have been licensed for weight loss include Orlistat and liraglutide. It is important to highlight to patients that this is often not a long-term solution, and side effects of the medications may result in reduced adherence. 

Orlistat is licensed in patients with a mild hypocaloric diet with a BMI of ≥30 kg/m2 or a BMI ≥ 28 kg/m2 associated with co-morbidities. Orlistat functions by inhibiting gastric and pancreatic lipase, increasing faecal fat excretion. Studies have shown this results in modest weight loss. The most common side effect is diarrhoea, faecal incontinence, flatus with discharge, abdominal cramping and oily spotting. This is contraindicated in patients with chronic malabsorption syndrome and should be used with caution in patients with CKD.  

Liraglutide has also been licensed with a caloric-reduced diet and increased physical activity. It can be used in patients with a BMI of ≥35 kg/m2 with associated T2DM or cardiovascular risk factors. Liraglutide is a GLP-1 agonist and mimics the function of GLP-1. It is associated with reduced glucagon secretion and delayed gastric emptying. It is associated with nausea, vomiting and diarrhoea. It is rarely associated with pancreatitis and renal impairment. If the patient has type-2 diabetes, this may be an ideal treatment option because it improves glycemic control and reduces weight loss.