Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Orlistat is a drug that promotes loss of
weight by preventing the digestion and absorption of fat in food. In the
intestine, an enzyme called lipase (produced primarily by the pancreas) breaks
apart fat in food so that it can be absorbed into the body. Orlistat blocks the
action of lipase and thereby prevents the breakup and absorption of fat.
Orlistat blocks absorption of about 25% of the fat in a meal. The unabsorbed fat
is excreted in the stool. The FDA approved Orlistat by prescription in 1999.
alli, a lower dose formulation of orlistat, was approved for purchase without a
prescription "over the counter" in 2007.
STORAGE: Capsules should be stored at room temperature, 15-30 C
(59-86 F)
PRESCRIBED FOR: Orlistat is combined with a reduced-calorie diet to promote
weight loss. Orlistat also may be used to prevent weight gain after weight has
been lost. Candidates for treatment with orlistat are patients who are obese
with a body mass index (a measure of obesity) of more than 30 kg/m2. Candidates
also include patients with a body mass index of between 27 and 30 kg/m2 if other
risk factors for arteriosclerosis are present such as high blood pressure,
diabetes, and
elevated blood cholesterol or triglycerides. Based on several
scientific studies, the average weight loss that is achieved when orlistat is
taken as recommended for six months to one year is 12.4 to 13.4 pounds.
DOSING: The recommended prescription dose for Xenical is one capsule (120 mg)
three times daily. The recommended dose for alli is 60 mg three times daily.
Orlistat should be taken one hour after or during a meal containing about 15 mg
of fat. Meals without fat do not require orlistat. No additional benefit has
been shown when orlistat was taken in doses greater than 120 mg. Patients should
eat a nutritionally balanced, reduced calorie diet that contains approximately
30% of calories from fat. alli includes an individually tailored online weight
loss support program.
Some dietary vitamins bind to fat (vitamins A, D, E and beta- carotene). When
orlistat is taken, these vitamins are not absorbed and are eliminated in the
stool in increased amounts along with the fat. Therefore, patients taking
orlistat should take a multivitamin containing these "fat-soluble" vitamins to
ensure that adequate amounts of the vitamins are available for absorption. To
ensure that the vitamins in the multivitamins are not bound to fat like the
vitamins in the diet, the multivitamin should be taken at least two hours before
or several hours after the orlistat.
DRUG INTERACTIONS: The blood thinning effect of warfarin (Coumadin) depends
on the amount of vitamin K in the body, and vitamin K is one of the vitamins
that binds to fat. Patients receiving warfarin who begin orlistat should have
their blood clotting monitored closely because the orlistat may cause levels of
vitamin K to decline. This will increase the effects of warfarin and lead to
abnormal bleeding from the warfarin. There is no evidence that a deficiency of
vitamin K occurs in patients who are taking orlistat.
Orlistat may reduce the absorption and blood levels of cyclosporine
(Sandimmune) when both drugs are administered together. Therefore, cyclosporine
should be administered two hours before or after orlistat, and more frequent
monitoring of cyclosporine levels may be needed.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
The definition of obesity varies depending on what one reads, but in general,
it is a chronic condition defined by an excess amount body fat. A certain amount
of body fat is necessary for storing energy, heat insulation, shock absorption,
and other functions. The normal amount of body fat (expressed as percentage of
body fat) is between 25%-30% in women and 18%-23% in men. Women with over 30% body
fat and men with over 25% body fat are considered obese.
The calculation of body mass index (BMI) has also been used in the definition of obesity. The body mass index (BMI) equals a person's weight in kilograms (kg) divided by their height in meters (m) squared. Since BMI describes body weight relative to height, it is strongly correlated with total body fat content in adults.
"Obesity" is defined as a BMI of 30 and above.
How common is obesity?
Obesity has reached epidemic proportions in the United States. One i...
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