The Effect of Orlistat-Induced Weight Loss, Without Concomitant Hypocaloric Diet, on Cardiovascular Risk Factors and Insulin Sensitivity in Young Obese Chinese Subjects With or Without Type 2 Diabetes

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Abstract
OBESITY IS considered by the World Health Organization to be a chronic disease and a massive public health problem.1 The rising prevalence of childhood obesity and young-onset diabetes mellitus in Asian populations represents major health care challenges because of the frequent coexistence of multiple risk factors and their long duration of disease.2,3 Many studies have confirmed the close associations between obesity and type 2 diabetes, hypertension, dyslipidemia, insulin resistance, and albuminuria.4-9 The clustering of these risk factors acts synergistically to increase cardiovascular morbidity and mortality. A weight reduction of 5% to 10% has been shown to improve the cardiovascular risk profile and glycemic control.10-15 Apart from dietary restriction and lifestyle modification, pharmacological agents are often used in weight reduction programs. Orlistat is an inhibitor of the gastrointestinal lipase that reduces the absorption of dietary fat by about 30%.16 Previous studies have confirmed the efficacy of orlistat in weight reduction with improvement in cardiovascular risk factors among obese white subjects.17-24 In contrast, there is a paucity of data on the efficacy of these drugs in Asian populations, despite the high prevalence of relative obesity in these countries.25 Moreover, given the close relationships among insulin resistance, obesity, and cardiovascular risk factors, the effects of orlistat treatment on insulin sensitivity have not been fully examined. To date, most of these studies were conducted in conjunction with a closely supervised hypocaloric diet. Although several studies suggest that weight reduction in obese subjects with diabetes was less than that in subjects with glucose tolerance values within the reference range when given the same dosages of orlistat, these studies were conducted in different clinical settings.17,22 In this study, we compared the efficacy of 6-month orlistat treatment on weight reduction, cardiovascular risk factors, and insulin sensitivity between young obese Chinese subjects with or without type 2 diabetes in a general medical clinic setting.