• Investigation of Orlistat as an intervention for obesity and cardiovascular risk factors: A systematic review

      Fallows, Stephen; Wrigley, Daniel K. (University of Chester, 2010-09)
      Background – Obesity is an ever increasing problem in modern society. Numerous pharmacological interventions have been introduced to combat the detrimental effects of this major health issue, including the lipase inhibitor, orlistat. Objectives – To investigate, and assess, the pharmacological effect of two differing doses of orlistat (xenical® 120mg; and alli™ 60mg), on weight loss parameters and cardiovascular risk factors. Search Strategy – Studies were obtained through computerised searches of MEDLIN, PUBMED, CINAHL, EMBASE, The Cochrane Library, Web of Knowledge, and from manual searches in recognised scientific journals. Selection Criteria – Randomised controlled trials in adult only subjects, of any study duration, comparing orlistat against surgical interventionm alternative medical intervention, and placebo, for weight loss and cardiovascular risk factors. Data Extraction & Synthesis – One reviewer independently assessed relevant studies, risk of bias, and extracted data. Main Results – Nineteen studies deemed relevant were included for final review. No study included cardiovascular mortality as an outcome. All studies reported significant (p<0.05) weight loss in orlistat treated patients from baseline to end of treatment. Most frequent side effects were mainly gastrointestinal in nature. Onset of diabetes progression was reduced in orlistat patients. Other cardiovascular risk factors were shown to decrease in orlistat patients. Conclusion – In patients with body mass index ≥27kg/m², orlistat, sibutramine, and metformin reduce body weight to a similar degree. Orlistat reduces waist circumference to the greatest degree. Orlistat induces greater gastrointestinal side effects and a greater attrition rate. Alli™ needs greater investigation of effects.