1. Dr. Daz (Karoline) Harding GP in Public Health NHS Wiltshire
Compliance with Orlistat Prescribing Guidelines – An Assessment Amongst Wiltshire General Practitioners
Dr. Daz (Karoline) Harding
GP in Public Health
NHS Wiltshire

2. The ‘scale’ of the problem
13% of adult men
16% of adult women were obese in 1993
22% of adult men
24% of adult women were obese in 2009

3. The future? Foresight study (2009) By 2050 60% of males and
50% females
will be obese

4. Orlistat NICE recommended 3 months treatment - £94.89
In 2008 total cost to the NHS was £44.8 million
Tenfold rise in cost since 1998

5. Wiltshire costs 2009-2010 total cost of Orlistat £239,287.63
Further £76, on Sibutramine
Prescribing costs vary from £0 to £

6. 2006 NICE Obesity Guidelines
Orlistat can be started
‘only after dietary, exercise and behavioural approaches have been started and evaluated’ in patients with a BMI >28kg/m2 plus co-morbidities or >30kg/m2
And continued
‘For longer than three months only if the person has lost 5% of their initial body weight since starting drug treatment, less strict in type II Diabetes’

7. Method Questionnaire sent to all 63 practices 39 were returned (62%)
Audit of ten adult patients started on Orlistat at the ten highest prescribing practices.
Nine of the ten practices participated

8. 12% had no BMI documented before prescription
7% had a waist circumference taken
46% had no supervised period of lifestyle change
52% had no referral to weight/exercise scheme
72% had no goal weight discussed
15% achieved a 5% weight loss over 3 months
50% did not complete three months of treatment
70% of those who did not achieve 5% weight loss at 3 months were continued on the medication
One in ten was not compliant
Several had Orlistat on their repeat prescription list

9. Questionnaire 69% always trialled lifestyle change
28% always enforced a 5% weight reduction or cessation
7.5 out of 10 – difficulty rating managing obesity
Hurdles and suggestions

10. Discussion Documentation Higher v lower prescribers
Not always following guidance

11. Local guidance
Lifestyle and Prescription contracts
Lifestyle leaflets widely available with ‘Ten Top Tips for weight loss’
Physical Activity on Referral
Fund independent slimming clubs on the NHS

12. Expected reduction in prescribing for 2011-2012 £73,244
Disseminate information amongst local GPs