Jim W.
Age 37
Height 5'8"
Weight 185 lbs
Initial Lipid Profile:
HDL 33 mg/dL
LDL 220 mg/dL
LDL/HDL ratio 6.7
TC 304 mg/dL
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Dyslipidemia, BMI 28
Profile and History:
Jim W., a 37-year-old white male, has been your patient for 10 years and has been seeing you because of an elevated lipid profile.
- His father died at the age of 48 of a myocardial infarction, and there is a history of familial hypercholesterolemia.
- Jim is married, with two children, and works as a construction foreman.
- His HDL was 33 mg/dL and his LDL was 220 mg/dL for an LDL/HDL ratio of 6.7. His TC was 304 mg/dL and his triglycerides were 255 mg/dL.
- Jim takes two cholesterol-lowering drugs, simvastatin (80 mg/day) and cholestyramine (5 pkts/day).
- Following this treatment, his HDL increased to 37 mg/dL, his LDL decreased to 165 mg/dL, and his LDL/HDL ratio is 4.5. His TC is 252 mg/dL and his triglycerides are 250 mg/dL.
- You have also asked him to restrict his dietary intake of saturated fat and cholesterol.
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Diagnosis and Identification:
- Recently he has gained some weight, an additional cause of concern. His weight is now 185 pounds, with a height of 5'8". His BMI is 28. In addition his lipids and his family history heightens his cardiovascular risk.
- Jim needs to lose some weight. In light of his family history and lipids Jim has been fairly compliant with his medical regimen. Because he is motivated, he's a good candidate for XENICAL, which could improve his lipids even further.
More on identifying patients at risk
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Counseling:
When discussing your concerns about his weight with Jim, he claims that he is sticking to his diet and exercise plan. With some additional prodding, he also says that his promotion to construction foreman has somewhat limited his daily physical activity. He further claims that it has been very difficult to lose any weight even when he sticks to his diet and exercise plan. When you explore the reasons why he is having these difficulties, Jim acknowledges that he has "slips" in his diet regimen that discourage him from continuing with the diet.
More on counseling your patient
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Treatment:
- Treatment goals for Jim include weight loss, an improved dyslipidemic profile and reduction in cardiovascular risk.
- To assist Jim with his weight loss, a prescription for XENICAL, a diet plan and an activity plan are appropriate.
- Jim must control the lapses in his diet regimen. For help in tracking his success, Jim should be encouraged to keep records of his daily food intake and exercise, as well as the weight he has lost. Jim should bring these records with him to his next monthly visit.
More on treatment and management
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Follow-Up:
Jim returns to your office in 4 weeks. He has lost 4 lbs and is on his way to improving his lipid profile. He still has occasional lapses, but does not use them as an excuse to stop dieting altogether.
More on follow-up care
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Lipid Levels
- The changes from randomization following 1-year treatment in the population with abnormal lipid levels (LDL >130 mg/dL, LDL/HDL >3.5, HDL <35 mg/dL) were greater for patients on XENICAL plus diet compared to patients on placebo plus diet with respect to LDL cholesterol (-7.83% vs. +1.14%) and the LDL/HDL ratio (-0.64 vs. 0.46). HDL cholesterol increased in the placebo group by 20.1% and in the XENICAL group by 18.8%.
Population as a Whole
XENICAL Plus Diet: Successful Weight Loss
In clinical trials involving 1064 patients, 69% on XENICAL plus diet lost 3% or more of initial body weight within 3 months, with a mean loss of 13 lbs.18
The mean change in total cholesterol was -2.0% for patients on XENICAL plus diet and +5.0% for patients on placebo plus diet. The mean change in LDL cholesterol was
-4.0% for patients on XENICAL plus diet and +5.0% for patients on placebo plus diet. The mean change in HDL cholesterol was +9.3% for patients on XENICAL plus diet and +12.8% for patients on placebo plus diet.
In clinical trials, the overall mean weight loss from randomization to the end of 1 year in the intent-to-treat population was 13.4 lbs in patients treated with XENICAL plus diet versus 5.8 lbs in placebo-treated patients.
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The long-term effects of orlistat on morbidity and mortality associated with obesity have not been established.
The patient depicted here is fictitious and is intended to illustrate an obesity-related comorbidity for which a treatment regimen including XENICAL plus a reduced-calorie diet is appropriate.
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