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Review: orlistat and sibutramine are modestly effective for weight loss at 1 year

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 Q What is the effectiveness of anti-obesity medications in trials with ⩾1 year follow up?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★☆☆ Endocrine ★★★★★★☆


Embedded ImageData sources:

Medline (1966 to December 2002), EMBASE/Excerpta Medica (1980 to December 2002), Cochrane Controlled Trials Register (Issue 3, 2002), Current Controlled Trials metaRegister of Controlled trials (December 2002), bibliographies of relevant studies, and experts and manufacturers.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) of approved anti-obesity agents for weight loss or weight maintenance in adults with body mass index (BMI) ⩾30 kg/m2 or ⩾27 kg/m2 plus ⩾1 obesity related comorbid condition (eg, coronary artery disease, stroke, type 2 diabetes, heart failure, dyslipidaemia, hypertension, reproductive or gastrointestinal cancer, gallstones, fatty liver disease, osteoarthritis, and sleep apnoea), had blinding of patients and healthcare providers, included a placebo group or another anti-obesity drug group, used an intention to treat analysis, and had ⩾1 year of follow up. Studies of off-label therapy; drugs with high addiction potential that preclude long term use; or investigational, herbal, or alternative compounds were excluded. Study quality was assessed.

Embedded ImageOutcome:

weight loss at 1 year.


Only trials of orlistat and sibutramine met the selection criteria. 16 RCTs (11 of orlistat and 5 of sibutramine) were included. 14 RCTs (11 of orlistat and 3 of sibutramine) were weight …

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  • For correspondence: Dr R Padwal, University of Alberta and Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada. rpadwal{at}

  • Source of funding: no external funding.