title: Orlistat, sibutramine, or combination therapy: which performs better on waist circumference in relation with body mass index in obese patients?
abstract: The aim of this study was to evaluate decrease in waist circumference in obese patients receiving different anti-obesity treatments. The study was designed as a short-term (12 weeks), open-label, and randomized trial. Eighty six patients (70 females, 81.4%; mean age 41.09+/-8.73 years, mean BMI 36.1+/-4.3 kg/m2) were randomized to four different therapy groups. The primary outcome parameters were waist circumference and body mass index (BMI). The therapy groups were a) diet+sibutramine 1 x 10 mg/d (n=22), b) diet+orlistat 3 x 120 mg/d (n=25), c) combination of diet+sibutramine+orlistat (n=20) and d) diet (n=19). Combination therapy was more effective than diet and orlistat mono-therapy (p<0.0001 for all), but not significantly superior to sibutramine mono-therapy (p=0.072) in decreasing BMI. Sibutramine mono-therapy was significantly more effective in inducing BMI decrease compared with orlistat mono-therapy (p=0.039). The association between change in BMI and change in waist circumference was strongest in the orlistat mono-therapy group (P interaction=0.003). This means that patients taking orlistat experienced more decrease in waist circumference (3.4 cm, R2=0.29) per unit decrease in BMI compared to patients under combination therapy (2.6 cm, R2=0.25, P interaction = 0.015) and patients taking sibutramine (1.8 cm, R2=0.19, P interaction=0.026). In the diet therapy group decline in waist circumference was independent of BMI (1.9 cm, R2=0.02, P interaction=0.076). Although combination therapy and sibutramine mono-therapy were more effective in decreasing BMI, reduction in waist circumference and BMI was most significantly associated with the orlistat mono-therapy group. This may hint at the possibility of orlistat inducing weight loss mainly in the abdominal area targeted to reduce cardiovascular risk.
authors.affiliation: Department of Internal Medicine, Haydarpaşa Numune Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Aydin
authors.forename: Pinar
authors.initials: P
authors.lastname: Topsever
authors.forename: Ayça
authors.initials: A
authors.lastname: Kaya
authors.forename: Müzeyyen
authors.initials: M
authors.lastname: Karasakal
authors.forename: Celal
authors.initials: C
authors.lastname: Duman
authors.forename: Arslan
authors.initials: A
authors.lastname: Dağar
mesh_terms: D000328:Adult; D000886:Anthropometry; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D001835:Body Weight; D003131:Combined Modality Therapy; D003503:Cyclobutanes / Q000627:therapeutic use*; D004038:Diet, Reducing; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy*; D000077403:Orlistat; D013223:Statistics as Topic
chemical_list: D019440:Anti-Obesity Agents; D003503:Cyclobutanes; D007783:Lactones; D000077403:Orlistat; C058254:sibutramine