Sold in the U.S. under the trade name Xenical, orlistat is the most widely-used drug for treatment of obesity. Xenical is also the only weight loss drug approved by the Food and Drug Administration (FDA) for long-term use. The reason Xenical is the top weight loss drug is simple: it’s effective.
Analysis of data from a pool of recent clinical trials has shown that Xenical taken in conjunction with lifestyle changes helps with weight loss. Xenical plus increased physical activity and lower calorie intake results in an average loss of 2 to 3 kg (4.4 to 6.6 lbs) more than these lifestyle changes alone over the course of a year.
Xenical has also been shown to reduce blood pressure, and may prevent onset of type 2 diabetes. Whether this effect is due to the weight loss itself or the drug has not been determined; but in a large, randomized, controlled clinical trial, Xenical was shown to reduce incidence of type 2 diabetes by almost 40% in people who are obese.
Why Waist Circumference Is Important
Weight and body mass index (BMI) do not appear to be as important in predicting weight-related health problems as waist circumference and waist-to-hip ratio. Higher waist circumference (WC) and higher waist-to-hip ratio (WHR) are correlated with higher risk of death from cardiovascular disease. This correlation appears to be roughly linear, in that risk increases with increased WC and WHR. By contrast, BMI appears to only be related to mortality from cardiovascular disease when age and sex are adjusted for. In short, the presence of abdominal fat is a better predictor of cardiovascular disease risk than BMI alone.
If you’re unsure how big your WC has to be to be correlated with increased risk of cardiovascular disease, a good rule of thumb is that your waist measurement should be less than half your height. In other words, if you are 5-foot-10 (70 inches) tall, your waist should measure 35 inches or less for better health.
Xenical and Waist Circumference
Decrease in WC after six months of treatment with Xenical was 2.15 cm greater than treatment with a placebo, and 6.96 cm greater than treatment with lifestyle changes alone. After one year, Xenical was associated with decrease in WC of 2.32 cm compared with placebo, and a decrease of 2.63 cm compared to lifestyle changes alone. Studies with a newer drug, Belviq, did not show significant effects on WC.
Health Benefits of a Smaller Waistline
Once a person’s waist circumference reaches half his or her height, risk for cardiovascular disease grows along with WC, and people whose waistlines reach 80% of their height (a waist measurement of 56 inches in someone with a height of 5-foot-10) shorten their lifespans by 17 years.
The reason WC is so important is that fat located behind the abdominal wall is metabolically active, and the chemicals produced by this type of fat affect functioning of the cardiovascular system. When the cardiovascular and other organs are exposed to the chemicals produced by abdominal fat, the result can be heart disease, kidney disease, and diabetes. Decreasing WC can decrease these risks.
Possible Future Treatments
Analysis of the data showed that the combination of Xenical with sibutramine (which is no longer on the market) had an even greater effect on waist circumference. The fact that a combination of drugs was more effective suggests that in the future other drug combinations, such as Xenical and Belviq, may be worth studying.
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