Drugs Used in the Treatment of Obesity

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.

A multicomponent approach should be adopted to reduce weight. Pharmacological treatment should only be considered after dietary, exercise and behavioural approaches have been started and evaluated.

Medicines should never be used as the sole element of treatment. They should be used in conjunction with a mildly hypocaloric diet rich in fruit and vegetables, exercise and behaviour management.

Weigh to Go is a free weekly adult weight management group with groups running in venues across Lanarkshire. For more information see https://www.nhslanarkshire.scot.nhs.uk/weigh-to-go/

NORTH LANARKSHIRE: https://www.nhslanarkshire.scot.nhs.uk/services/weight-management-service/weigh-to-go/

SOUTH LANARKSHIRE: https://www.slleisureandculture.co.uk/info/506/sllc_gyms/848/weigh_to_go

Information on healthy eating and lifestyle, nutrients in food and weight loss can be found at www.bda.uk.com/foodfacts/home

Anti-Obesity Drugs Acting on the Gastro-Intestinal Tract

Total list (T)

ORLISTAT

  • Orlistat should only be used where diet, physical activity and behavioural changes are supported.
  • Orlistat should be considered as an adjunct to lifestyle interventions in the management of weight loss.
  • Patients with BMI ≥28 kg/m2 (with comorbidities) or BMI ≥30 kg/m2 should be considered on an individual case basis following assessment of risk and benefit. 
  • Therapy with orlistat should be continued beyond 12 weeks only if the patient has lost at least 5% of their initial body weight since starting drug treatment. Therapy should then be continued for as long as there are clinical benefits (e.g. prevention of significant weight re-gain).

 

Specialist initiation (S1)

LIRAGLUTIDE (Saxenda®)

  • All patients prescribed Saxenda® should be being managed by clinicians in the NHS Lanarkshire Weight Management Service. Please refer to the NHS Lanarkshire guideline 'Liraglutide (Saxenda®) as an Adjunct to Lifestyle Measures in Weight Management' for further information.
  • Prescribe by brand name.
  • Liraglutide (Saxenda®) is restricted for use in adult patients with prediabetes and who have a high risk of cardiovascular disease, who are engaging with a Lanarkshire Weight Management Service (LWMS) intervention, in line with SMC Advice SMC2455 Saxenda®.
  • Saxenda® should only be considered as an adjunct to lifestyle interventions in the management of weight loss, and is restricted to use in those with a BMI ≥35kg/m2. A lower BMI cut-off may be more appropriate for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.