Results from SMOMS (Scandinavian Study on Orlistat in the Metabolic Syndrome) showed that patients with the metabolic syndrome who were taking orlistat lost a significant difference of weight compare to those on the identical lifestyle programme who were taking placebo. The incidence of new cases of type 2 diabetes was 5.2% in those taking orlistat and 10.0% among controls; there was a 10.5% incidence of cardiovascular disease among those on orlistat, and a 17.3% incidence among those on placebo.
A randomized study of orlistat as an adjunct to life style changes for the prevention of type 2 diabetes in obese subject (XENDOS study) concluded that compared with life style changes alone, orlistat plus lifestyle changes resulted in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinically representative obese population
PCOS affects 5% to 10% of women in their reproductive years and is the most common endocrinopathy affecting women. PCOS is a chronic hyperandrogenicstate that has short-term and long-term implications for patients such as excessive body hair (hirsutism), amenorrhea, infertility, diabetes mellitus, and cardiovascular disease. A prolonged exposure to unopposed estrogen can lead to endometrial hyperplasia and endometrial carcinoma. Women with a BMI of greater than 27 kg/m2 are considered overweight, and they are often insulin resistant. Women with a BMI of > 30 kg/m2 are considered obese and are almost always insulin resistant. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of insulin resistance is obesity. The pancreas initially responds to insulin resistance by producing more insulin. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus insulin resistance is a pre-diabetes condition
Weight loss can decrease the amount of circulating androgens and, thus, will induce ovulation. Weight loss is also associated with decreased insulin and testosterone levels and an improved lipoprotein profile. Orlistat produced a significant reduction in weight and total testosterone. The reduction in total testosterone was similar to that seen after treatment with metformin. Orlistat may prove not only as useful adjunct in the treatment of PCOS but increase ovulation rate as well. Clinicians need to be aware of the early recognition, diagnosis, treatment, and the risk factors for PCOS. Intervening with preventive approach could restore normal menstrual function, ovulation, and fertility. These patients usually do the best when many members of a healthcare team, including a nutritionist, are actively involved in their care.
