Obesity (BMI > 30 kg/m) is now such a prevalent condition, particularly in industrialized countries, that the WHO has officially declared it a pandemic. In many European countries the prevalence of obesity is about 15% of the adult population and in US 20-25% of all adults are obese. In many parts of the world obesity is doubling every five to ten years, and projection suggests that this pandemic will create huge health burdens. These relate not only to the cost associated with management of obesity, but also to associated co morbidities, including glucose metabolism disorders, hypertension and hyperlipidemia, which may ultimately lead to Type 2 diabetes and cardiovascular disorders. It is generally accepted that it is the so-called Western lifestyle that is the cause of the obesity epidemic with its increasing sedentary lifestyle and free access to high fat foods and soft drinks twenty-four hours per day. It has, however, been difficult to demonstrate the exact cause and by looking on the energy balance it is quit easy to understand why. By following a population in Denmark, the group who developed obesity was, characterized by a rather slow weight increase - 23.5 kg over 20 years which corresponds to an increase in BMI from 24 (= normal weight) to 33.3 kg/m (= obesity). It can be calculated that the increase in body weight was 3.35 g per day corresponding to a surplus of energy of about 120 kJ/day or a few gram of fat or butter per day or about 6 min less walking per day. These changes are so small that they cannot be registered by questionnaire used in surveys or by interview investigations.
Treatment of obesity is primarily based upon lifestyle changes with dietary reduced anti-diabetic treatment as compared with placebo.
Adverse effects of Xenical are mostly related to gastrointestinal (GI) problems and can be anticipated from the known action of Xenical with increasing fat content in the stool. The most common adverse effects are flatus with discharge, oily spotting, fecal urgency, fatty/oily stools, and fecal incontinence. These GI events generally occur early during treatment, are mild to moderate in intensity and are generally transient and can be reduced by maintaining allow fat diet. In randomized studies Xenical treatment is not associated with enhanced frequency of withdrawal indicating that the adverse effects are mild and generally acceptable. In conclusion lifestyle interventions are important in the treatment of obesity but if they are used alone the success rate is rather minor. Addition of a well tolerated anti-obesity drug such as Xenical to lifestyle modifications seems to improve both the absolute weight loss as well as weight loss maintenance and improves several of the risk factors and co morbidities associated with obesity. Finally, it is important to emphasize for the obese patients that realistic weight losses are in the range of 10-15 % which also are associated with important health benefits - going for more pronounced weight loss (e.g. normalization of body weight) would most likely results in disappointment and frustration.
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