Hello everyone! In this month’s blog post, we thought we’d take on a more clinical topic and have a closer look at the evidence surrounding drug treatment options for obesity. To start off with, obesity is defined as a BMI ≥ 30 kg/ m2 and is a condition very closely linked to other comorbidities, such as cardiovascular disease (CVD) and type two diabetes mellitus.(1) Obesity, including childhood obesity is becoming more of a concern, with rates increasing in the UK and worldwide.(2) In 2017, 61% of adults in England were classified as overweight or obese.(3) Obesity levels were found to be greatest in adults aged 45-74, and obesity is generally more common in men than women.(3)
Pharmaceutical treatment in the UK isn’t that widely available or well-known, and currently orlistat is the only agent licensed specifically for obesity treatment when lifestyle interventions alone are not sufficient. Orlistat is used in both adults BMI ≥ 30 kg/ m2 and children over 12 years and is supported by a lot of high quality short-term evidence.(4,5,6) For producing a ≥5% reduction in body mass in one year, orlistat has a reported number needed to treat of 10.(7) Longer term follow-up suggests orlistat is effective initially, during the first 4 months of treatment, but this weight loss is not maintained.(2)
Lorcaserin is an anti-obesity drug licensed in the US, supported by evidence demonstrating a significant increase in weight loss compared with a placebo.(7) The number needed to treat has been reported as 5 for a decrease in body mass ≥5% in one year, and 8 for a decrease in body mass ≥10% in one year.(7)
Use of metformin in childhood obesity treatment has been shown to reduce patient BMI measurements.(5,6) RCT evidence also suggests linoleic acid is effective in lowering BMI and body fat.(6)
Most of the evidence available regarding drug treatments for obesity is low quality due to high study drop-out rates and limited long-term follow-up after administration. Severe cardiac and psychological side effects have been reported in other medications previously used for obesity,(5) which has resulted in their withdrawal from the market despite high quality evidence indicating their effectiveness in reducing BMI and waist circumference.(6)
As its now spring and we’ve already seen a lot of social media posts about summer bodies, we just want to take this opportunity to emphasise that the APC supports both feeling body confident and the maintenance of a healthy lifestyle. There are healthy lifestyle weight loss options which should be implemented before drug use, for example eating 5 fruits and vegetables a day, reducing fat intake and getting 30 minutes of aerobic exercise 5 days a week.(8) Having said this, there are always ways we can be healthier, and we would emphasise the importance of a healthy diet and physical exercise, regardless of an individual’s BMI or weight. If anyone you know is interested in starting a weight-loss diet or pharmacotherapy, it is definitely worth discussing this with a GP or registered pharmacist as a lot of the information out there right now can be misleading and inaccurate.
Stay tuned for next month’s blog post, where we’ll be updating you on some big changes to the APC committee. In the meantime, keep following us on social media for regular updates: Alternative Pharmacy Careers Conference (Facebook) and @altpharmcareers (Twitter and Instagram).
References:
(1)- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/treatment-summary/obesity.html (Accessed 24/03/2019).
(2)- Douglas IJ, Bhaskaran K, Batterham RL, and Smeeth L. The effectiveness of pharmaceutical interventions for obesity: weight loss with orlistat and sibutramine in a United Kingdom population-based cohort. British Journal of Clinical Pharmacology. 2015; 79(6):1020-1027.
(3)- Baker C. Obesity Statistics. House of Commons Library Briefing Paper; Number 3336, 20 March 2018.
(4)- Padwal RS, Rucker D, Li SK, Curioni C, and Lau DCW. Long‐term pharmacotherapy for obesity and overweight. Cochrane Database of Systematic Reviews. 2003.
(5)- Mead E, Atkinson G, Richter B, Metzendorf M-I, Baur L, Finer N, Corpeleijn E, O'Malley C, and Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database of Systematic Reviews. 2016.
(6)- Rajjo T, Mohammed K, Alsawas M, Ahmed AT, Farah W, Asi N, Almasri J, Prokop LJ, and Murad MH. Treatment of Pediatric Obesity: An Umbrella Systematic Review. The Journal of Clinical Endocrinology & Metabolism. 2017; 102(3): 763–775.
(7)- MacDaniels JS, and Schwartz TL. Effectiveness, tolerability and practical application of the newer generation anti-obesity medications. Drugs in Context. 2016; 5: 1-7.
(8)- NHS Website. Live Well. Available at: https://www.nhs.uk/live-well/ (Accessed 27/03/2019)
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