The new obesity guidance: The new obesity guidance Steve Garbutt


Introduction: Introduction NICE due to report on Obesity on 27 February 2007 Brought forward to report on 6 November 2006 Consultation on first (and only) draft from 16 March 2006


Aims and objectives: Aims and objectives To recap on the existing guidance and then compare the new guidance in the draft report for each of the following interventions Orlistat (Xenical) Sibutramine (Reductil) Bariatric surgery


Orlistat – existing guidance: Orlistat – existing guidance Technology appraisal 22 NICE March 2001


Orlistat - existing: Orlistat - existing Age 18-75 and BMIandgt;30 or 28 plus co-morbidity Lose 2.5kg in one month by diet and exercise before initiate treatment Lose 5% at 3 months Lose 10% at six months Not usually recommended beyond 12 months and never beyond 24 months


Orlistat - proposed: Orlistat - proposed Same BMI’s apply No 'run in' period No 10% at six month rule


Orlistat - proposed: Orlistat - proposed Recognise that diabetics may have slower rate of weight loss and that 'less strict goals of weight loss…should be agreed with the individual'


Orlistat - proposed: Orlistat - proposed Use after 12 months, usually for maintenance, should be after discussion with the individual about risks and benefits


Orlistat: Orlistat Use in 12-16 year olds with severe physical or psychological co-morbidity under specialist supervision and with a 6 month trial period Use under 12 in exceptional circumstances by specialists only


Sibutramine - existing: Sibutramine - existing Technology appraisal 31 NICE October 2001


Sibutramine - existing: Sibutramine - existing Same BMI’s as orlistat 18-65 year olds who have made 'serious attempts to lose weight by diet, exercise and/or other changes in their behaviour'


Sibutramine - existing: Sibutramine - existing Must lose 2kg in first month Must lose 5% at 3 months


Sibutramine - proposed: Sibutramine - proposed 'emerging evidence of longer term use for maintenance and prescribers should be aware of the latest evidence' For children within the same limitations as orlistat


Obesity surgery: Obesity surgery Technology appraisal 46 NICE July 2002


Obesity surgery - existing: Obesity surgery - existing BMI andgt;40 or andgt;35 and comorbidity Only if been receiving intensive management in a hospital obesity service All appropriate and available non-surgical measure been adequately tried and failed to maintain weight loss


Obesity surgery - existing: Obesity surgery - existing Generally fit for anaesthesia and surgery Understand the need for long term follow up No physical or psychological contraindication as assessed by specialist multidisciplinary unit


Obesity surgery – existing: Obesity surgery – existing No firm evidence for efficacy or cost effectiveness of one particular procedure and so should be chosen between surgeon and individual according to best available evidence


Surgery - proposed: Surgery - proposed Surgery recommended as a first line option in individuals with BMIandgt;50 and in whom surgery is considered appropriate


Surgery - proposed: Surgery - proposed Drug treatment no recommended as first line treatment in individuals considered suitable for surgery However may be used as an interim measure to maintain or reduce weight prior to surgery where waiting times are considered excessive


Surgery - proposed: Surgery - proposed Procedure chosen according to degree of obesity, co-morbidity, evidence, facilities and experience of surgeon


Surgery - proposed: Surgery - proposed Children may be considered in an adult unit where specialist paediatric dietetic, anaesthetic, psychologist and physician care also available


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