By Jim Dryden
November 2, 2001
University investigators have shown that a weight-loss drug, orlistat, can help prevent obese people from absorbing cholesterol from their food. They reported their findings in the journal Obesity Research.
"This is the first time that a medication for obesity has been shown to block the absorption of cholesterol," said Samuel Klein, M.D., the Danforth Professor of Medicine and Nutritional Science at the School of Medicine. "The results from our study suggest that orlistat therapy in obese patients may have beneficial effects on blood cholesterol that are independent of its effects on body weight."
Previous clinical trials have shown that orlistat, commercially known as Xenical, blocks the absorption of dietary fat and that obese subjects who dieted and took orlistat lost more weight than those who dieted and took an inactive placebo. In addition, those who lost weight while taking orlistat had lower blood-cholesterol levels than those who slimmed down without the drug. University researchers wanted to learn why.
"The results from large clinical trials found that obese subjects who lost weight by dieting and taking orlistat with meals had a greater reduction in blood-cholesterol concentration than those who lost the same amount of weight by dieting without orlistat," said Klein, who also serves as director of the University's Center for Human Nutrition.
The researchers studied 18 patients with abdominal obesity and fed them meals containing 72 milligrams of cholesterol. In one part of the study, participants received a standard meal 10 to 20 days apart in order to test the accuracy of using radioactive tracers to measure the amount of cholesterol absorbed from food. The method was developed by Richard E. Ostlund Jr., M.D., professor of medicine and a co-investigator in this study.
"The technique uses oral and intravenous administration of non-radioactive, stable isotope tracers of cholesterol," Ostlund said. "It allows us to accurately measure the absorption of cholesterol from a standard meal."
The test showed that the amount of cholesterol absorbed remained the same when the subjects ate the meal on two different occasions. The investigators then tested cholesterol absorption from the meal with and without orlistat. When test participants ate the meal with orlistat, they absorbed 25 percent less cholesterol than when they ate the test meal without the drug.
"The results from our study suggest that orlistat reduces plasma cholesterol concentrations in obese people by reducing absorption of cholesterol from the diet," Klein said.
"But it is important to remember that the cornerstone of obesity therapy involves the difficult process of making lifestyle changes in dietary intake and physical activity," Klein said. "Orlistat and other drugs can be used as additional tools to help selected patients successfully achieve long-term weight management. But drug therapy should be used only as part of a comprehensive weight-management program that includes medical exams, dietary counseling, education about physical activity and behavior modification."
Klein noted that even modest weight loss --5 percent to 10 percent of body weight --combined with lower cholesterol levels can have significant health benefits for obese patients.
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