Abstract #1394102: Orlistat for Weight Loss: Remembering All the Tools of the Trade

New medications like the gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) have been making headlines as more effective weight loss medications. However, in light of recent manufacturing delays, cost side effects, older should still be considered. A 58-year-old female with history metabolic syndrome depression presented to endocrinology clinic discuss On presentation, she was at her maximum 205 pounds (BMI 37.5). She previously enrolled Veterans Affairs Hospital ‘MOVE’ program started metformin 1000mg twice a day minimal loss. Her insurance did not cover GLP-1 RAs both bupropion-naltrexone phentermine-topiramate were contraindicated since already taking bupropion had kidney stones. The patient on orlistat 120mg three times day, which tolerated, 2 months 4% 197 36). Over next 7 lost an additional 16 32.9) no longer qualified for bariatric surgery. After 2.5 years, has 57 27.1, 28% loss), A1c decreased from 6.8% 6.1%, total cholesterol 202 127, LDL 101 58 (atorvastatin 10mg added same time orlistat). now self titrates based meals averages medication one two day. Orlistat functions by inhibiting gastrointestinal lipases, resulting absorption fat 30%. It shown promote maintain average 3.8%, well reduce risk developing type diabetes lower cholesterol. While other medications, such bupropion-naltrexone, phentermine-topiramate, contraindications patients significant cardiac history, hyperthyroidism, seizures, pancreatitis, contraindications. This is ideal who eat high diet or do want administer injections limiting factor effects fatty stool fecal incontinence, occur approximately 25% patients. These decrease frequency long-term use are reduced when given psyllium. In summary, this case highlights appropriate patient.