Orlistat should only be prescribed for people who have lost at least 2.5 kg in weight by diet and exercise in the month before their first prescription and have either:
– a body mass index (BMI) of 28 kg/m2 or more in the presence of significant other diseases which persist despite standard treatment. (E.g. Type 2 diabetes, high blood pressure and/or high total cholesterol level).
– a BMI of 30 kg/m2 or more.
I think these guidlines would also apply to Cetilistat.
With Orlistat (Xenical) just under a third of the fat that would otherwise have been absorbed passes straight through the bowel and is excreted in the faeces. As a result it can mean that a person taking orlistat may feel the urgent need to go to the toilet, an increase in the number of times they need to go to the toilet, and when they do go they produce 'fatty stools'. Often with they have anal-leakage or oily spotting of their underwear. These effects encourage people taking the drug to limit their fat intake.
Don't get me wrong, people limiting their fat intake is a good thing of course, but this is why the drop-out rate in the Xenical trials was much higher. The fact is, overeating in some people is a disorder & it is not as easy as just saying "eat less". If this were true there would be no call for pharmacological intervention. Obesity is now such a large scale problem that NICE have even endorsed surgical intervention (i.e. gastric banding) for the morbidly obese, which carries huge risks.
The bottom line is a change in lifestyle is always the most favourable outcome, and generally drugs are unsuitable for use as a sole Tx, but the most important thing is the weight loss, however this is achieved, because dangerously overweight people have a high incidence of morbidity/mortality due to compications associated with their weight.
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