Zenical/Orlistat

[CherylG]

Hi

Its a new year and I seriously need a new start with my health! I am 18st 2lb female and at 5ft 2in have a body mass index of 46!!!! Help! So I guess half of me is fat! My GP has given me zenical/Orlistat which made me feel great....at last someone is trying to help me! But, then when I got the pills I read the leaflet and was a bit scared at the side affects. Part of the weight is emotional eating and not eating 3 meals a day, just one usually. The other part is that I am taking Amitripyline, Gabapentin to name a few of my medications, which were prescribed by the Hospital Pain Clinic Consultant after trying a whole host of other pain relief treatments that failed to work.

Basically, I have researched Zenical/Orlistat but cannot find any eating plan? All I find is that you must have 30% healthy fats in your diet or the pills will not work? How do I measure that? To be honest, I don't want to start taking them until I understand or find other guidance because of some of the side affects scare me and I don't want to make myself iller through ignorance. I suffer from errosive gastritis and IBS for starters, I also have sleep apneoa, narcolepsy, neuralgia/adhesions from surgery, 2 prolasped discs in my lower back, osteoarthritis in both hips, neck pain, high blood pressure, inherited cholesterol, cartilidge problems in my right knee and am vitamin B12 deficient (which I have injections for). I have an allergy to histamine, and have to watch foods that promote histamine, for example yeast! I'm not even sure how many calories I should start with etc?

Sorry if I've waffled a little, I just want to get on the right track and spend most of my time being ill or in pain and desperately want to get out of this never ending cycle that I've got myself in......BUT......I want to get it right.

Thank you for reading this, hopefully you might be able to advise me

[Dr James Thompson]

Hi Cheryl,

Thanks for getting in touch with TalkHealth's online weight loss clinic.

Orlistat is the only available prescription medication for assisted weight loss. It works by preventing your gut from absorbing fat, which means that the fat that would normally be digested is left in your stool. The main side-effect reported is therefore unpleasant fatty stools and diarrhoea. These side-effects can be minimised by eating a diet that is lower in fat. If you have got IBS I can understand your concern about a drug that could upset your bowels.

If you are wanting more information about fats then there is a good resource on the British Heart Foundation website http://www.bhf.org.uk/heart-health/prev ... d-fat.aspx which explains all about good and bad fats. It is the bad fats that are more likely to bring on the unpleasant side-effects with Orlistat if you do choose to take it.

Chronic pain is a well known cause for low mood and depression and a clinical feature of depression is overeating - would you describe your "emotional eating" as this? If so it might be worth discussing a possible depression diagnosis with your GP - if you can improve your mood it may reduce the emotional eating.

If you are wanting more help with diet choices take a look at this British Heart Foundation page also http://www.bhf.org.uk/heart-health/prev ... plate.aspx it gives you lots of information about the choices you make regarding the food you eat. Trying to implement the advice you find here and eating smaller, more regular meals is likely to help with your weight loss goals.

Hope this helps!

Dr James Thompson
www.askdocjames.com

[CherylG]

Many thanks for your reply, that has eased my worry a little. Yes I do eat mainly when my moods are low, especially when in pain, so I will do as you directed and talk to my GP. Thank you again!

Cheryl

[Jenny Radcliffe]

Hello CherylG

With your BMI and health problems you would meet the NICE criteria for weight loss surgery (though different areas have their own rules about who can get funding & you may be expected to show 6 or 12 months of concerted effort to lose weight through diet and exercise) and it may be worth talking to your GP about this.

You mention that you are an emotional eater; even if you were offered surgery it would be important that you stabilise your eating habits. When people rely on food to manage difficult feelings or have binge episodes they can encounter emotional and physical problems after surgery. You might want to look at my posts in the emotional eating and weight loss surgery section of this clinic.

Good luck.

[Denise Kennedy]

Hi Cheryl,
Further to the advice already given by you asked about how many calories to aim for. I would suggest that if you aim for 1500 - 1700 this should result in slow steady weight loss, without making you feel too hungry.

Try to set yourself some goals to work towards. I would especially suggest that you aim to eat 3 regular meals a day, with a healthy balance of foods at each meal. You say you eat one meal now - maybe aim for 2 to start with. Plan in advance what you are going to eat and shop according to your plan. Keeping a food and mood diary helps lots of people, write down everything you eat and drink, and how you were feeling at the time. Maybe there are other things that you like doing, or that need doing, and try these distraction activities when you feel the urge to eat.

You should aim to increase the lower calorie foods in your diet, such as fruit and vegetables. How about some lovely warming vegetable soups to warm you up in the snowy weather and they can be really filling. This is a great recipe for "Hearty Vegetable Soup" http://www.nhs.uk/Livewell/healthy-reci ... -soup.aspx.

There are still plenty of vegetables you can eat, even with histamine intolerance. There is some additional good information on this condition here - http://www.allergyuk.org/common-food-in ... ntolerance.

Good luck - and remember - one step at a time.

Histamine i

[Dr Masud Haq]

Hi Cheryl

I would echo some of the recommendations that have already been given.
It sounds as if you require some additional emotional support from your GP. Binge eating and similar habits often lead to patients struggling with their weight. Without appropriate support you're more likely to be unsuccessful with any weight loss plan.
As Jenny, has outlined, you do meet the NICE criteria to be offered weight loss surgery but your local commissioning panel will want to see evidence that you've engaged in trying to lose weight with the support of a dietitian for at least 6-12 months.
The current NICE criteria are BMI > 40 in non-diabetics and BMI > 35 in diabetes patients. Associated conditions such as high blood pressure and cholesterol, obstructive sleep apnoea, arthritis, and lower back pain strengthen your case to be offered surgery.

Best of luck.
Masud