A new drug for obesity which prevents fat from being absorbed by the body was approved for use in the NHS yesterday, but strictly limited to those whose weight is a serious medical problem.
Orlistat (brand name Xenical) is the first anti-obesity drug that does not work by suppressing the appetite. It has been hailed as potentially one of a new breed of lifestyle drugs. Weight reduction, like conquering social shyness and ending impotence, can be seen in the context of quality of life rather than serious damage to health.
The decision that the NHS should pay for orlistat, announced by the national institute for clinical excellence (Nice), came with conditions to make sure that only those whose health and in some cases life is threatened by their weight will get it.
The patient must also show they are committed to losing weight and keeping it off by shedding at least 2.5kg in the previous month through ordinary diet and exercise.
The tablets are not a miracle cure. They have to be used in conjunction with dieting and exercise and offer their own rather unpleasant incentive to cut down on fat intake. They work by reducing the capacity of the body to absorb fat. Any surplus passes straight through the gut and is excreted with some urgency.
Most patients will not be prescribed orlistat for longer than a year and none should have it longer than two years, Nice says. They will only be allowed to stay on the pills if they manage to lose at least 5% of their body weight every three months.
Peter Littlejohns, clinical director of Nice, said: "Doctors and patients need to work together to manage this condition and today's guidance provides advice on the contribution which orlistat can make."
The Nice decision is partly a response to the worrying in crease in obesity in the UK, which looks set to follow the pattern in the United States. Some 11,000 seriously overweight people are likely to be prescribed the pills, at a cost to the NHS of £12m a year. Even this represents savings on the bill for treating medical conditions which can be a consequence of obesity over many years.
Ian Campbell, chairman of the National Obesity Forum, said: "The decision underlines the importance of treating obesity and the overweight - an epidemic that is having an alarming impact on our nation's health - before it is too late.
"By treating obesity and overweight we can reduce the burden of disease linked to obesity, such as coronary heart disease and diabetes."
Around 61% of British men and 52% of women are thought to be overweight, while 16% and 18% respectively are clinically obese and therefore likely to have damaged health. As in the US, children seem to be following in the fatness trend. A survey found that in the last 10 years there has been a sharp increase in the numbers who are overweight, customarily put down to junk food, and too much television and computer game-playing.
The national audit office said recently that the inactivity and overeating, which causes obesity, were killing 31,000 people prematurely a year. In 10 years, it said in a report, the UK could catch the US, where a quarter of the population is obese.
Orlistat will only be given to those with a body/mass index of over 30 kg/m2 or 28 kg/m2 if they have a serious illness such as diabetes or high blood pressure. Body mass index is the person's weight in kilograms divided by their height in metres squared. A BMI of 20 to 25 is normal, 25 to 30 is overweight and more than 30 is obese. A man of about 5ft 10in weighing more than 15 stone or a woman of 5ft 6in and 13.5 stone would be regarded as obese.
