Obesity is on the increase in the rich countries, exposing patients to an increased risk of diabetes, arterial hypertension, various cancers, osteoarthritis of the knee and sleep apnoea. Slimming drugs are available but many of them have been withdrawn from the market due to their adverse effects.

It is unfortunate that orlistat is being sold over the counter in France in 60 mg capsules. Already on the market as a prescription treatment for obesity at a dose of 120 mg, orlistat offers a benefit that at best can be described as minimal (loss of 3 kg in 6 to 12 months of treatment), in addition to non-drug measures. Worse, it frequently causes adverse effects, especially digestive (oily anal discharge, diarrhoea sometimes with blood in the stools, faecal incontinence and abdominal pain), disorders associated with a lower absorption of vitamins, risks of drug interactions (in particular with oral contraceptives) and rare cases of pancreatitis and hepatitis.

Health authorities have decided to make orlistat available over the counter, although it has such a limited role to play in the treatment of obesity.

Obese patients can be helped to lose weight without drugs, via a balanced, moderately low-calorie diet, that is not excessively rigid, more exercise and individual support.

©Prescrire April 2009

Source: "Orlistat à demi-dose sans ordonnance (Alli°) Rev Prescrire 2009; 29 (305): 173-175.

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