4.5 Drugs used in the treatment of obesity

NICE CG43 Obesity (December 2006) provides strategic guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. It provides key priorities for implementation that includes public health support, drug therapy and surgery.

Drug therapy would only be considered after dietary, exercise and behavioural approaches have been started and evaluated. Drug therapy is not recommended in children under 12 years of age and only in certain circumstances in children 12 years and older by a multidisciplinary team experienced in prescribing for this age group. For adults, drug therapy would be considered for those who have not reached their target weight loss, who have reached a plateau or who are being considered for surgery. Drug therapy should only be prescribed as part of an overall plan for managing obesity. The use of drug therapy without an overall strategy for managing obesity may detract from patients making longer-term healthy lifestyle changes.

  • NICE TA494: Naltrexone-bupropion is not recommended for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity (December 2017)

Lipase inhibitors

  • Capsules 120mg (£18.44 = 84)


  1. Orlistat should only be prescribed in adults who meet one of the following criteria:
    • A BMI of 30kg/m2 or more.
    • A body mass index (BMI) of 28kg/m2 or more with associated risk factors.
  2. Continuation of therapy beyond 12 weeks should continue only if the patient has lost at least 5% of their initial body weight from the start of drug therapy.
  3. Health care professionals will need to decide whether the anticipated weight loss (generally 5%) is of clinical significance to their patients. If prescribed, the patient should be counselled on the adverse effect profile associated with orlistat, particularly in connection with gastrointestinal adverse effects.
  4. Orlistat 60mg capsules are now available OTC at approximately £50 for 28 days treatment.


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