DR Medhat MRCP

■ Sibutramine
- Withdrawn January 2010 by the European Medicines Agency due to an
increased risk of cardiovascular events.
- Centrally acting appetite suppressant (inhibits uptake of serotonin and
noradrenaline at hypothalamic sites that regular food intake).
- Adverse effects include hypertension (monitor blood pressure and pulse during
treatment), constipation, headache, dry mouth, insomnia and anorexia.
- Contraindicated in psychiatric illness, hypertension, IHD, stroke, arrhythmias
■ Rimonabant
- A specific CB1 cannabinoid receptor antagonist.
- was withdrawn in October 2008 after the European Medicines Agency warned
of serious psychiatric problems including suicide.
2) Surgical treatment :
■ Bariatric surgery (NICE guidelines on bariatric surgery for adults)
o Consider surgery for people with severe obesity if:
1. They have a BMI ≥ 40 kg/m2 , or between 35-40 kg/ m2 + other significant
disease (e.g T2DM, hypertension) that could be improved if lost weight.
2. All appropriate non-surgical measures have failed to achieve or maintain
adequate clinically beneficial weight loss for at least 6 months.
3. They are receiving or will receive intensive specialist management.
4. They are generally fit for anaesthesia and surgery.
5. They commit to the need for long-term follow-up.
6. Consider surgery as a first-line option for adults with a BMI of more than 50 kg/
m2 in whom surgical intervention is considered appropriate.
7. Consider orlistat before surgery if the waiting time is long.
o Types of bariatric surgery:
1) Primarily restrictive: laparoscopic-adjustable gastric banding (LAGB) or sleeve
gastrectomy.
2) Primarily malabsorptive: classic biliopancreatic diversion (BPD) has now
largely been replaced by biliopancreatic diversion with duodenal switch.
3) Mixed: Roux-en-Y gastric bypass surgery
o Which operation?
1) LAGB produces less weight loss than malabsorptive or mixed procedures but as
it has fewer complications it is normally the first-line intervention in patients
with a BMI of 30-39kg/ m2.