Indications and initiation

• Consider drug treatment for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes.​

• Make the decision to start drug treatments after discussing the potential benefits and limitations with the person, including the mode of action, adverse effects and monitoring requirements, and the potential impact on the person's motivation. Make arrangements for appropriate healthcare professionals to offer information, support and counselling on additional diet, physical activity and behavioural strategies when drug treatment is prescribed. Provide information on patient support programmes.

Orlistat

Only prescribe orlistat as part of an overall plan for managing obesity in adults who meet one of the following criteria:

• a BMI of 28 kg/m2 or more with associated risk factors
• a BMI of 30 kg/m2 or more.

Continue orlistat therapy beyond 3 months only if the person has lost at least 5% of their initial body weight since starting drug treatment. Also see below for advice on targets for people with type 2 diabetes.

Make the decision to use drug treatment for longer than 12 months (usually for weight maintenance) after discussing potential benefits and limitations with the person.

The co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended.

Continued prescribing and withdrawal

Pharmacological treatment may be used to maintain weight loss, rather than to continue to lose weight.

If there is concern about micronutrient intake adequacy, a supplement providing the reference nutrient intake for all vitamins and minerals should be considered, particularly for vulnerable groups such as older people (who may be at risk of malnutrition) and young people (who need vitamins and minerals for growth and development).

Offer support to help maintain weight loss to people whose drug treatment is being withdrawn; if they did not reach their target weight, their self-confidence and belief in their ability to make changes may be low.

Monitor the effect of drug treatment and reinforce lifestyle advice and adherence through regular review.

Consider withdrawing drug treatment in people who have not reached weight loss targets (see above for details).

Rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate. Agree the goals with the person and review them regularly.