NICE also recommends considering orlistat when initiating treatment, but only for those with a BMI of 28 kg/m2 or more, along with advice around realistic weight loss and calorie intake modification.7

Weight loss should be reviewed after 12 weeks and a decision taken on whether to continue with orlistat if the patient has not lost at least 5% of their original body weight. This decision should also reflect the fact that €as with adults who have type 2 diabetes, those at high risk of the condition may lose weight more slowly than average, so less strict goals may be appropriate.€

Where hypertension is a consideration, and lifestyle interventions have not proved effective, NICE recommends as the first line treatment a once-daily angiotensin-converting enzyme (ACE) inhibitor. If needed, antihypertensive therapy should be stepped up using either a calcium-channel blocker or a diuretic (usually a thiazide or thiazide-related diuretic), and then adding in the other type if dual therapy is insufficient.12

For a person of African or Caribbean family origin, initial therapy should be an ACE inhibitor plus either a diuretic or a calcium-channel blocker, while for women with a possibility of becoming pregnant, a calcium channel blocker is the first choice.