BMJ. 2007 Dec 8;335(7631):1194-9.
Long term pharmacotherapy for obesity and overweight: updated meta-analysis.
Rucker D, Padwal R, Li SK, Curioni C, Lau DC.
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Objectives:
To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.
Design:
Updated meta-analysis of randomised trials.
Data Sources:
Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006. STUDIES REVIEWED: Double blind randomised placebo controlled trials of approved anti-obesity drugs used in adults (age over 18) for one year or longer.
Results:
30 trials of one to four years' duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine lowered concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders.
Conclusions:
Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.
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- 1 What is infertility?
- 2 How prevalent are infertility problems?
- 3 What are the main causes of infertility?
- 4 What are the objectives of our infertility investigations?
- 5 Have there been any noticeable changes in fertility requirements in recent years?
- 6 What is the effect of our age on fertility?
- 7 I smoke cigarettes. Can this have an effect on my fertility?
- 8 Does my weight influence fertility?
- 8A Obesity! How can I lose weight?
- 9 I have fibroids. Could these reduce my fertility?
- 10 I have been told that my womb has an abnormal shape and that was the way that I was born. Could this reduce my fertility?
- 11 I have endometriosis. Could this reduce my fertility?
- 12 I have been told that I have cervicitis or a cervical ectopy (erosion). Could this impair my fertility?
- 13 My doctor tells me that my womb is retroverted (tilts backwards). Could this reduce my fertility?
- 14 I have had an ectopic pregnancy. Does this affect my future fertility?
- 15 We are worried that we may have a fertility problem. What should we do?
- 16 How will our doctor be able to identify the cause of our infertility?
- 17 How can we tell if I am releasing my eggs (ovulating)?
- 18 Investigations have shown that I have a problem releasing my eggs (anovulation). What could be the cause of this?
- 19 How important are my Fallopian tubes in fertility?
- 20 How can we tell if my Fallopian tubes are functioning?
- 21a What are the causes of male factor infertility?
- 21 How can we assess male fertility?
- 22 What is the purpose of a post-coital test (PCT)?
- 23 We have had our infertility investigations and our problem remains unexplained. How can this be?
- 24 What are our chances of achieving a pregnancy?
- 25 Where can I obtain more information?
- 26 Could we have some recommended infertility support groups?
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