December 1, 2023

What is Orlistat?

A drug that has been in use since the Nineties, “Orlistat works by reducing the amount of fat that people absorb from their gut when they eat,” said Dr Miras.

Does it work?

Orlistat works by expelling some of the fat people take in from meals. According to Dr Miras: “The resulting diarrhoea is so unpleasant, it effectively punishes you for having eaten fat. It makes the person learn to cut down on the fat in their diet.

“When that happens, and there are people who do that, then these people do well with their weight loss. However, the weight loss is small, and the side effect – diarrhoea – is pretty severe.” 

Is it safe/FDA approved?

Orlistat is safe to use and approved by the FDA. Side effects can be unpleasant – if you eat fatty food, you’re likely to suffer from offensive-smelling diarrohea.

Will my medical insurance cover Orlistat and is it available on the NHS?

The NHS will prescribe Orlistat to people with a BMI of 30 or more, or those with a BMI of more than 28 who also have a risk factor such as Type 2 diabetes, hypertension or familial high cholesterol. Orlistat is covered by medical insurance in the US, depending on your plan.

How is it taken?

In tablet form, before meals.

The drug that’s been around for a while

What is it?

Saxenda (generic name liraglutide) is an antidiabetic medication used to treat Type 2 diabetes and chronic obesity.

Does it work?

“Like Wegovy and Ozempic, Saxenda also mimics the hormone GLP-1, leading to a feeling of fullness,” explained Dr Hameed. But it has a shorter “half-life” than Ozempic and Wegovy and has to be taken every day.

Is it safe/FDA approved?

Saxenda is approved by the FDA for chronic weight management in adults with a BMI over 30. Side effects are similar to Wegovy and Ozempic and include tiredness, dizziness, stomach problems and gallstones.

Am I the right candidate and how quickly will I see results?

Trial data suggest that people taking Saxenda for 56 weeks lose, on average, 1st 4lb (8.4kg), or eight per cent of their body weight.

As with Ozempic and Wegovy, people put the weight back on when they stop: in this case, an average of 2.9kg (6lb) after 12 weeks.

Will my medical insurance cover Saxenda and is it available on the NHS?

Saxenda is covered by many insurances and is available on the NHS. 

In the UK, it is prescribed via specialist NHS weight-loss services for people with a BMI of 35 or above, who have prediabetes and at least one cardiovascular risk factor, such as hypertension or high cholesterol.

You have to do “homework” before you are prescribed it. According to Nice guidance, you must lose at least five per cent of your body weight after 12 weeks on the full dose in order to continue with the medication.

How is it taken?

Also as a self-administered injection, at a dose of up to 3mg every day.  

If you would rather pop down to Boots or Holland & Barrett, which over-the-counter options are the most promising?  

Green coffee bean extract

In pill or powder form, this is currently popular and, says Dr Hameed, it “probably has a small effect on weight loss by increasing metabolism, similar to drinking caffeinated drinks”. 

She added: “A few short-term randomised clinical trials show it might help with losing a few pounds, but more robust, longer-term studies are definitely needed before any definitive conclusions can be drawn.”

Raspberry ketones 

Dr Hameed said: “Some in-vitro cellular experiments [in test tubes], as well as rodent studies, suggest that they may support weight loss by reducing food consumption, as well as increasing body-fat breakdown. 

“However, there is no good evidence from human studies to show that these supplements help with weight loss.”

Green tea extract 

This has been linked to liver damage and even liver failure. When it comes to supposed weight-loss properties, “the data are quite promising for mice,” according to Dr Duane Mellor, a senior teaching fellow at Aston Medical School and a spokesman for the British Dietetic Association. 

“So if your pet rodent has a weight problem, you might be on to something. But for humans? The data are pretty limited.”


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