Endocrine Abstracts

Introduction: Obesity is a chronic disease which becoming a worldwide pandemic. In the UK it’s estimated that around one in every four adults living with obesity. The mainstay of intervention to manage weight is lifestyle modification includes eating a healthy, reduced-calorie diet and regular exercise. There are different pharmacological therapy agents for medical management of obesity, However, currently NICE recommended weight-loss agents are limited to Orlistat and GLP-1 RAs includes liraglutide and semaglutide. Mechanism of action of orlistat is inhibiting the absorption of dietary fats via the inhibition of lipase enzymes.

Case history: A 60-year-old female has been referred by the Surgical Tier 4 Services for consideration of medical management while she awaits a laparoscopic sleeve gastrectomy. As far as her weight is concerned, she describes herself been overweight since she was a child and she reported to gain more weight gradually with a period over the last six decades. She has tried multiple diets and increasing her physical activity over the years, but this has not been sustainable. Her past medical history includes hypertension, obstructive sleep apnoea on CPAP and pancreatitis secondary to gallstones. She had strong family history of obesity. The diagnosis of lymphoedema has also not helped with performing regular exercise. The only medication she takes is Ramipril. Examination did not show signs of endocrinopathy, and Bariatric blood screen was not significant including full blood counts, liver function, bone profile, folate, vitamin B12, vitamin D, Iron study, CRP, thyroid function, HbA1c, renal Function and lipid Profile.

Management: The most significant success to weight loss was achieved through lifestyle modification and also taking orlistat about 20 years ago when she manged to lose significant amount of weight but because of the gastrointestinal side effects she had in the past she never went back on orlistat again. Her recent weight was 237.6 kg with a height of 181.5 cm making a BMI of 72.1 kg/m^2. She has been advised to change her lifestyle again by reducing portion sizes, reducing the number of takeaways and restarted on Orlistat. She has also looked into online courses for increasing exercises but it was unaffordable for her. She has lost 10.2 kilogram in 6 weeks.

Discussion: This case illustrates significant weight reduction with lifestyle modification combined with orlistat. As currently there is national shortage of GLP1 agonists, therefore the option of orlistat should be considered as pharmacological option for weight management