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CONTINUING PROFESSIONAL DEVELOPMENT
Intensive interventions to support
weight loss should be considered as
an adjunct to lifestyle intervention
for adults who have a BMI >30 kg/m2
(or >27 kg/m2 with comorbidities) and/
or have been unsuccessful in reducing
or prevention weight regain with lifestyle
Intensive interventions include
weight-loss medicines and very low-
energy diets, as well as bariatric surgery.
There is evidence that using
pharmacotherapy in addition to
lifestyle changes increases weight
loss in adults that are overweight
Two medicines, orlistat
and phentermine, are approved for
the treatment of overweight (with
comorbidities) and obesity.
Although not specifically indicated
for the treatment of overweight and
obesity, a number of other medicines
including fluoxetine, topiramate,
metformin, glucagon-like peptide
agonists can effect weight. These
medicines may be beneficial for weight
management when treating the relevant
1,12 See Table 2.
There is no evidence to support the use
of any complementary or alternative
medicines for the treatment of
overweight and obesity.
Orlistat is approved in Australia as
a Pharmacist Only medicine for the
treatment of adults with a BMI >30 kg/
m2 (or >27 kg/m2 with comorbidities).
Orlistat inhibits pancreatic and gastric
lipases to reduce the absorption of
dietary fat. It must be used in conjunction
with a modified diet low in fat.
In conjunction with lifestyle changes,
treatment with orlistat can achieve
modest weight loss of 2–4 kg.
It is associated with increased weight
reduction compared to placebo or
behavioural interventions, with an
average increase weight loss of 3 kg
after 12 months.6,15 In addition, orlistat
reduces low-density lipoprotein to a
greater degree than weight loss alone,
and may also have beneficial effects
on triglycerides, waist circumference
and blood pressure.
In people with
diabetes, weight loss associated with
orlistat improves glycaemic control.
At present, orlistat is the only
weight-loss medicine with evidence of
efficacy and long-term safety.
Table 2. Summary of weight management medicines
Common adverse effects
Mean weight loss
Treatment of obese patients (BMI >30)
or overweight patients (BMI >27) with
Flatulence, oily spotting faecal urgency,
loose stools, nausea, reduce vitamin
2.9 kg (CI:3.5–2.3) at 12 months
Short-term (max 3 months) treatment
(BMI >30) or overweight patients (BMI
>25) with associated comorbidities
Palpitations, tachycardia, hypertension,
CNS stimulation, headache,
constipation, dry mouth, impotence
3.6 kg (CI: 6.0–0.6) following 2–24 weeks
Treatment of type 2 diabetes
NB: not approved for treatment of
GI upset, taste disturbance, vitamin B12
depletion, LFT abnormality, hepatitis,
Women of reproductive age prone to
infertility: 0.68 BMI (CI: 1.13–0.24) after
Without diabetes, treated with
antipsychotics: 4.8% body weight (CI:
8.0–1.6) after 12–14 weeks
GI upset, hypoglycaemia, anorexia,
headache, antibody formation,
hyperhidrosis, jitteriness, injection site
reaction, nasopharyngitis, URTI, back
Without diabetes: 3.2 kg (CI: 4.3–2.1) after
With diabetes: 2.8 kg (CI: 3.4–2.3) after
GI upset, hypoglycaemia, anorexia,
antibody formation, dyspepsia, GORD,
headache, injection site reaction, URTI
Adapted from Grima et.al12
Phentermine is a Prescription Only
medicine. It is a central nervous
system stimulant and indirect-acting
sympathomimetic agent, that creates
an energy deficit by supressing appetite
to reduce food intake, and possibly
stimulating energy expenditure.
It is approved for the short-term
treatment (e.g. 12 weeks) of adults with
a BMI >30 kg/m2 (or >25 kg/m2 with
12,13 Compared to placebo,
phentermine therapy is associated with
a weight reduction of 3.6 kg after
2–24 weeks of treatment.
The long-term safety of phentermine
therapy has not been established.
Continued use may be associated with
tolerance and reduced efficacy, as well as
increased risk of dependence and abuse.
Very low-energy diets
Very low-energy diets (VLEDs) have
the motivating effect of rapid weight
loss. VLEDs are defined as interventions
that provide between 1,675 and
3,350 kilojoules per day. They are
useful for adults with BMI >30 kg/m2
or BMI >27 kg/m2 in the presence of
obesity-related comorbidities, but are
only suitable when used under medical
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