Prescrire Int. 2002 Feb;11(57):10-2.
(1) Treatments for obesity are disappointing, and none has yet shown an effect on morbidity or mortality. Non drug treatments have not been assessed adequately. Long-term maintenance of weight loss requires long-term patient management. (2) Orlistat, a gastrointestinal lipase inhibitor, is licensed in Europe for the treatment of obesity, in combination with a low-calorie diet. (3) The risk-benefit ratio of orlistat could not be estimated from the initial assessment file in 1999. There were fears over a possible increase in the risk of breast cancer. (4) Few new efficacy data have been obtained since. Medium-term trials (12-24 months) show that orlistat (120 mg three times a day), combined with dietary intervention, has a minor supplementary effect on weight loss (-3.5 kg on average). (5) A meta-analysis of three of the four available comparative trials lasting two years failed to conclude that orlistat prevents the onset of type 2 diabetes. Likewise, there is no firm evidence that orlistat lowers cardiovascular morbidity or mortality. (6) Orlistat frequently has gastrointestinal adverse effects, and case reports of hypertension have been published. Orlistat probably interacts with a number of other drugs. (7) Follow-up of nearly 8,000 women for only a few years showed no increase in the incidence of breast cancer on orlistat. (8) In practice, dietary intervention and risk factor management remain the cornerstones in the management of obesity. Orlistat is only a minor, optional and temporary aid, although it appears so far to have no serious adverse effects.
(1) 肥胖症的治疗效果令人失望，尚无任何一种治疗方法显示对发病率或死亡率有影响。非药物治疗尚未得到充分评估。长期维持体重减轻需要长期的患者管理。(2) 奥利司他是一种胃肠道脂肪酶抑制剂，在欧洲被批准与低热量饮食联合用于治疗肥胖症。(3) 从1999年的初始评估文件中无法估计奥利司他的风险效益比。人们担心乳腺癌风险可能会增加。(4) 此后几乎没有获得新的疗效数据。中期试验（12 - 24个月）表明，奥利司他（每日三次，每次120毫克）与饮食干预相结合，对体重减轻有轻微的辅助作用（平均减轻3.5千克）。(5) 对四项可用的为期两年的比较试验中的三项进行的荟萃分析未能得出奥利司他可预防2型糖尿病发病的结论。同样，也没有确凿证据表明奥利司他能降低心血管疾病的发病率或死亡率。(6) 奥利司他经常有胃肠道不良反应，并且已经发表了高血压的病例报告。奥利司他可能与许多其他药物相互作用。(7) 对近8000名女性仅进行了几年的随访，结果显示服用奥利司他的女性乳腺癌发病率没有增加。(8) 在实际操作中，饮食干预和风险因素管理仍然是肥胖症管理的基石。奥利司他只是一种次要的、可选的和临时的辅助手段，尽管到目前为止它似乎没有严重的不良反应。
