Abstract
To describe the comparative efficacy of orlistat and sibutramine in an obesity management program, with specific attention to compliance and weight regains after noncompliance. We prospectively evaluated 182 obese patients who were randomized to treatment with orlistat (n=98) or sibutramine (n=84) along with the diet and exercise prescriptions. Compliance (or compliant patient) was defined as adherence to scheduled visit times (at 3-month intervals) and following the prescribed drug regimen. A telephone survey was conducted in case of noncompliance. Significant body weights improvements were seen in both treatment groups. Patients lost a mean of 7.6±2.8% and 10.5±2.9% of initial body weights after a mean drug use of 8.8±5.7 and 8.3±3.7 months in the orlistat and sibutramine groups, respectively (p<0.05 vs. initial body weight). Patients in the sibutramine group lost more weight than the orlistat group (p<0.05). A total of 102 patients (56%) were compliant (53.1% in the orlistat group and 59.5% in the sibutramine group). Factors associated with compliance included weight reduction of more than 5% in the first 3 months and adherence to physical activity. Higher initial body weight, prior anti-obesity therapy, number of concurrent medications, and comorbidity were associated with noncompliance. Weight regains in noncompliant patient were a mean of 5.2±5.1 kg after a mean period of 9.2±4.2 months in the orlistat group, and a mean of 6.1±3.8 kg after a mean period of 9.1±3.9 months in the sibutramine group (p<0.05 vs. last visit for both groups, p>0.05 between groups). Both drugs in an obesity management program can achieve substantial weight loss. However, noncompliance and rebound weight regain after noncompliance are considerable problems.
References
Baskin M.L., Ard J., Franklin F., Allison D.B.: Prevalence of obesity in the United States. Obes. Rev., 6, 5–7, 2005.
James W.P., Astrup A., Finer N., Hilsted J., Kopelman P., Rossner S., Saris W.H., Van Gaal L.F.: Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance. Lancet, 356, 2119–2125, 2000.
van Baak M.A., van Mil E., Astrup A.V., Finer N., Van Gaal L.F., Hilsted J., Kopelman P.G., Rossner S., James W.P., Saris W.H.; STORM Study Group: Leisure-time activity is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance (STORM trial). Am. J. Clin. Nutr., 78, 209–214, 2003.
Krempf M., Louvet J.P., Allanic H., Miloradovich T., Joubert J.M., Attali J.R.: Weight reduction and longterm maintenance after 18 months treatment with orlistat for obesity. Int. J. Obes. Relat. Metab. Disord., 27, 591–597, 2003.
Moyers S.B.: Medications as adjunct therapy for weight loss: approved and off-label agents in use. J. Am. Diet. Assoc., 105, 948–959, 2005.
Leung W.Y., Neil Thomas G., Chan J.C., Tomlinson B.: Weight management and current options in pharmacotherapy: orlistat and sibutramine. Clin. Ther., 25, 58–80, 2003.
Hanif M.W., Kumar S.: Pharmacological management of obesity. Expert Opin. Pharmacother., 3, 1711–1718, 2002.
Kaplan L.M.: Pharmacological therapies for obesity. Gastroenterol. Clin. North Am., 34, 91–104, 2005.
Shepherd T.M.: Effective management of obesity. J. Fam. Pract., 52, 34–42, 2003.
Hensrud D.D., Weinsier R.L., Darnell B.E., Hunter G.R.: Relationship of co-morbidities of obesity to weight loss and four-year weight maintenance/rebound. Obes. Res., Suppl. 2, 217–222, 1995.
Elfhag K., Rossner S.: Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes. Rev., 6, 67–85, 2005.
Cooper Z., Fairburn C.G.: A new cognitive behavioural approach to the treatment of obesity. Behav. Res. Ther., 39, 499–511, 2001.
Jeffery R.W., Wing R.R., Mayer R.R.: Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients? J. Consult. Clin. Psychol., 66, 641–645, 1998.
Saris W.H.: Fit, fat and fat free: the metabolic aspects of weight control. Int. J. Obes. Relat. Metab. Disord., Suppl. 2, 15–21, 1998.
Schoeller D.A., Shay K., Kushner R.F.: How much physical activity is needed to minimize weight gain in previously obese women? Am. J. Clin. Nutr., 66, 551–556, 1997.
Hughes J.R.: Psychological effects of habitual aerobic exercise: a critical review. Prev. Med., 13, 66–78, 1984.
Borchelt M.: Important aspects of geriatric pharmacotherapy. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 48, 593–598, 2005.
Dezii C.M.: A retrospective study of persistence with single-pill combination therapy vs. concurrent two-pill therapy in patients with hypertension. Manag. Care, 9, 2–6, 2000.
Foster G.D., Wadden T.A., Vogt R.A., Brewer G.: What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes. J. Consult. Clin. Psychol., 65, 79–85, 1997.
Linne Y., Hemmingsson E., Adolfsson B., Ramsten J., Rossner S.: Patient expectations of obesity treatmentthe experience from a day-care unit. Int. J. Obes. Relat. Metab. Disord., 26, 739–741, 2002.
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Gursoy, A., Erdogan, M.F., Cin, M.O. et al. Comparison of orlistat and sibutramine in an obesity management program: Efficacy, compliance, and weight regain after noncompliance. Eat Weight Disord 11, e127–e132 (2006). https://doi.org/10.1007/BF03327578
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DOI: https://doi.org/10.1007/BF03327578