Treatment options for obesity and potential therapies on the horizon.

Orlistat (Xenical, Alli) Orlistat (Xenical, Roche) is one of only two medications approved by the FDA for the treatment of obesity. A lipase inhibitor, it prevents the breakdown of dietary triglycerides to fatty acids and monoglycerides. The prescribed dose of 120 mg three times daily is taken with meals and prevents approximately 30% of ingested fat from being absorbed.6 According to a meta-analysis published in 2005, orlistat is associated with a mean weight loss of 2.6 kg at six months and a mean loss of 2.9 kg at 12 months, after the weight loss observed in the control group is subtracted.7 However, adverse effects (AEs), including flatulence, steatorrhea, increased stool frequency, fecal incontinence, and oily fecal discharge, limit the use of orlistat.5 This agent can also cause decreased absorption of the fat-soluble vitamins A, D, E, and K. Patients should thus be encouraged to take a supplement containing these vitamins two hours before each orlistat dose.6 Orlistat is also available over the counter as Alli (GlaxoSmithKline) at a 60-mg dose. Dr. Motycka is Assistant Dean and Director at the University of Florida’s College of Pharmacy, Jacksonville Campus, in Jacksonville, Fla. Dr. St. Onge is Assistant Dean and Director at the university’s College of Pharmacy, Orlando Campus, in Apoka, Fla. Dr. Miller is a member of the Pharmacotherapy Faculty at Florida Hospital, Family Health Center East, in Orlando.