NPC Archive Item: Are NICE recommendations about monitoring patients on orlistat being followed?

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2 December 2010

A recent small study found that two thirds of adults in one GP practice who were taking orlistat for obesity continued to be prescribed the drug beyond three months even though they had failed to achieve sufficient weight loss. NICE specifically recommends that treatment is discontinued in such patients.

Healthcare professionals should continue to follow NICE guidance and ensure that adults who are taking orlistat are reviewed regularly, and their drug treatment continued only if they achieve significant weight loss. NICE recommends that the orlistat is continued beyond three months only if patients have lost at least 5% of their initial body weight since starting treatment. Patients who do not meet this criterion should stop treatment. Less strict goals may be appropriate for people with type 2 diabetes because their rate of weight loss may be slower than people without diabetes. Nevertheless, these goals should be agreed with the individual person and reviewed regularly.

What does this study say?
A recent study presented at the Royal College of General Practitioners’ annual conference identified 84 patients (aged 20 to 74 years), who had been prescribed orlistat at a selected GP practice between November 2008 and 2009. The researchers found that most patients (93%) met NICE criteria for starting the drug. However, two thirds (67%) were left on treatment after three months even if they had failed to lose at least 5% of their initial body weight since starting treatment.

This study is limited by the fact that it was very small and it looked at orlistat prescribing in only one GP practice. However, prescribing of orlistat has been identified as one area which offers opportunities for maintaining or improving quality, and improving value, within the wider QIPP agenda. This study should therefore prompt healthcare professionals to review orlistat prescribing within their localities, in order to ensure that it is in line with NICE guidance.

Orlistat should be prescribed only as part of an overall plan for managing obesity in adults after diet, exercise and behavioural approaches have have been tried. In addition, they must have a body mass index (BMI) of at least 30kg/m2, or at least 28kg/m2 with associated risk factors. The decision to continue treatment beyond 12 months (usually for weight maintenance) should be made after discussing the potential benefits and limitations with the patient.

More information on obesity can be found on the relevant section of NPC

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