Impact of orlistat therapy on weight reduction in morbidly obese patients after implantation of the Swedish adjustable gastric band.
BACKGROUND
Adjustable gastric banding (AGB) is frequently performed to treat morbid obesity. One problem which can occasionally develop after a restrictive procedure is consumption of a high calorie liquid diet, which may prohibit further weight loss. Orlistat, a newly developed intestinal lipase inhibitor, prevents absorption of about one-third of ingested fat. It is unknown whether patients no longer losing weight after AGB, despite further band restriction, may lose weight with addition of orlistat.


METHODS
38 patients were selected who had stopped losing weight 3 months before the initiation of the study, 18 +/- 6 months (mean +/- SEM) after laparoscopic AGB. Subjects were divided into 2 groups, matched for age, sex, filling volume of the band and body mass index (BMI) both at the time of surgery and start of the study (18 +/- 6 months after AGB).


RESULTS
Patients in group A received dietary counseling and orlistat 120 mg TID for 8 months, while patients in group B received only dietary counseling. During the following 8 months of study, subjects in group A lost 8 +/- 3 kg in weight, whereas subjects in group B lost 3 +/- 2 kg (p < 0.01, months 18 vs 26 of study; p < 0.03, group A vs B). In 15 patients from group A the study was further extended 9 months, but interestingly, weight remained stable independent of whether orlistat was continued (n = 8) or stopped (n = 7). 4 subjects were excluded from the extension study because of additional malabsorptive bypass surgery. Subjects taking orlistat encountered only minor GI side-effects.


CONCLUSIONS
Orlistat appears to be useful when added in patients after AGB who are no longer losing weight, perhaps due to a high-calorie liquid diet rich in fat.
Zoss
Isabelle
I
Hirslanden Clinic, Witellikerstr. 40, CH-8008 Zürich, Switzerland.
Piec
Grazyna
G
Horber
Fritz F
FF
D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D005260:Female; D015391:Gastroplasty; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000188:drug therapy* / Q000601:surgery; D000077403:Orlistat; D011184:Postoperative Period; D015431:Weight Loss / Q000187:drug effects*
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat