The goals of the College of Family Physicians of Canada include patient-centred care and social equity. In the debate published in the February issue,1 Drs Bourns and Shiau quote 2 randomized controlled trials.2,3 The rest of their references were to guidelines. Bourns and Shiau state that orlistat can cause oily stool, fecal urgency, and fecal leakage.1 The liraglutide product monograph says that it has been associated with tachycardia, first-degree atrioventricular block, nausea, vomiting, diarrhea, dehydration, renal failure, and pancreatitis (including 1 fatality).4
Wadden et al found that enhanced weight loss counseling helps about one-third of obese patients achieve clinically meaningful weight loss.2 They did not show that the treatment prolonged life or decreased hospitalization. Pi-Sunyer et al found that 3.0 mg of liraglutide as an adjunct to diet and exercise counseling was associated with reduced body weight and improved metabolic control.3 They did not show that the treatment was associated with prolonged life or decreased hospitalization. A secondary end point included health-related quality of life: “Liraglutide treatment was associated with higher scores on the SF-36 [36-Item Short Form Health Survey] for overall physical and mental health.”3 Substantially more patients taking liraglutide had nausea, diarrhea, and vomiting compared with those taking placebo.3 The cost of 3.0 mg of liraglutide a day is $200 a month.5
Bourns and Shiau have not shown that medication for obesity prolongs life or improves patient quality of life. Nonetheless, they recommend that we prescribe orlistat or liraglutide. Liraglutide is expensive and causes nausea, vomiting, and diarrhea, while the use of orlistat forces the patient to use diapers and to know the location of all the bathrooms in the neighbourhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.
The evidence suggests that we should not prescribe medications for obesity.
I thank Cliff Cornish and Robyn Ingvallsen of the Island Health Library Services for their help in finding articles.
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