The comparison of treatment with orlistat and orlistat plus metformin in relation to insulin resistance and weight loss

Introduction: Obesity is a growing health problem. Many drugs have been developed to treat obesity. Orlistat is a widely used drug to treat this disease. Metformin is an antidiabetic drug. Clinicians often prescribe it to treat insulin resistance and achieve weight loss. Our research aims to compare the effects of orlistat alone and its combination with metformin on weight loss and insulin resistance. Material and Method: This retrospective study was conducted by scanning the data of patients who presented to Antalya Training and Research Hospital Endocrinology, and General Surgery Clinics between 2016 and 2021. 42 morbidly obese patients who met inclusion and exclusion criteria and were prescribed orlistat plus metformin (group 1, n: 28) or orlistat alone (group 2, n: 14) along with a low-calorie diet for three months and were taking it regularly were included. Subsequently, weight, body mass index, fasting blood glucose, fasting insulin, and HOMA-IR (homeostasis model assessment for insulin resistance) were recorded and analyzed at baseline and after three months of taking the medications. Results: After 3 months of treatment, significant weight loss was achieved in both groups compared to baseline weight (p=0.001 group 1, p=0.003 group 2). HOMA-IR values decreased significantly in both groups (p=0.001 group 1, p=0.01 group 2). Both groups lost the same amount of weight after three months (p=0.06). Conclusion: In morbidly obese patients without prediabetes or diabetes, the addition of metformin to orlistat therapy did not add benefits in terms of weight loss or insulin resistance.

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  • Nicklas JM, Huskey KW, Davis RB, Wee CC. Successful weight loss among obese U.S. adults. Am J Prev Med 2012; 42: 481-5
  • Rössner S, Sjöström L, Noack R, Meinders AE, Noseda G. Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. European Orlistat Obesity Study Group. Obes Res 2000; 8: 49-61.
  • Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995; 333: 677-85.
  • Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992; 16: 397-415.
  • Heymsfield SB, Segal KR, Hauptman J, et al. Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch Int Med 2000; 160: 1321-6.
  • Heck AM, Yanovski JA, Calis KA. Orlistat, a new lipase inhibitor for the management of obesity. Pharmacotherapy 2000; 20: 270-9.
  • Tanakol R. Obezite Tedavisinde Orlistat. Turk Jem 2003; 7: 87-97.
  • Ballinger A. Orlistat in the treatment of obesity. Expert Opin Pharmacother 2000; 1: 841-7.
  • Kelley DE, Bray GA, Pi-Sunyer. Clinical efficacy of orlistat therapy in owerweight and obese patients with insulin treated-type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care 2002; 25: 1033-41.
  • Derosa G, Mugellini A, Ciccarelli L, Fogari R. Randomized, double-blind, placebo-controlled comparison of the action of orlistat, fluvastatin, or both an anthropometric measurements, blood pressure, and lipid profile in obese patients with hypercholesterolemia prescribed a standardized diet. Clin Ther 2003; 25: 1107-22.
  • Muls E, Kolanowski J, Scheen A, Van Gaal L; ObelHyx Study Group. The effects of orlistat on weight and on serum lipids in obese patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled, multicentre study. Int J Obes Relat Metab Disord 2001; 25: 1713-21.
  • Bloch KV, Salles GF, Muxfeldt ES, Da Rocha Nogueira A. Orlistat in hypertensive overweight/obese patients: results of a randomized clinical trial. J Hypertens 2003; 21: 2159-65.
  • Kay JP, Alemzadeh R, Langley G, D'Angelo L, Smith P, Holshouser S. Beneficial effects of metformin in normoglycemic morbidly obese adolescents. Metabolism 2001; 50: 1457-61.
  • Gokcel A, Gumurdulu Y, Karakose H, et al. Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity. Diabetes Obes Metab 2002; 4: 49-55.
  • Sari R, Balci MK, Coban E, Yazicioglu G. Comparison of the effect of orlistat vs orlistat plus metformin on weight loss and insulin resistance in obese women. Int J Obes Relat Metab Disord 2004; 28: 1059-63.
  • Freemark M, Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics 2001; 107: 55.
  • Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the study of Insulin Resistance (EGIR). Diabet Med 1999; 16: 442-3.
  • Song J, Ruan X, Gu M, Wang L, Wang H, Mueck AO. Effect of orlistat or metformin in overweight and obese polycystic ovary syndrome patients with insulin resistance. Gynecol Endocrinol 2018; 34: 413-7.
  • Berne C; Orlistat Swedish Type 2 diabetes Study Group. A randomized study of orlistat in combination with a weight management programme in obese patients with Type 2 diabetes treated with metformin. Diabet Med 2005; 22: 612-8.
  • Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002; 87: 1555-9.