The section on the metabolic syndrome gives further information on exercise as part of lifestyle modification. Medications Currently, only 3 weight-loss medications are approved by the US Food and Drug Administration for the long-term treatment of overweight and obesity (BMI 27 kg/m2 ) in the US general population: orlistat, the recently approved and the combination pill of phenter- mine and topiramate.245 Orlistat, a lipase inhibitor, has been tested in a small population of obese patients with Twenty-one patients with HF with a BMI 30 kg/ and LVEF <40% were randomized to orlistat plus di- etary counseling versus dietary counseling alone. Those randomized to orlistat for 12 weeks had significantly more weight loss ( 4.65 9.8 kg) compared with the control group (4.39 7.4 kg; P=0.04). Furthermore, the orlistat group had more improvement in 6-minute walk distance and in NYHA class compared with the control group. The safety of lorcaserin, an agonist of the 5-hydroxytrypta- mine (serotonin) receptor 2C, in patients with HF is un- known, and the initial US Food and Drug Administration approval includes a provision mandating postmarketing studies to assess for adverse cardiovascular effects. The combination of phentermine and topiramate has been ap- proved for use in adults with a BMI >30 kg/m2 and at least 1 weight-related condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia, but there are no data on patients with HF. The US Food and Drug Administra- tion s statement also includes a notation that the drug can increase heart rate and should not be used in those with unstable heart disease,245 and the sponsor is required to perform a long-term postmarketing study of cardiovascu- lar outcomes associated with the drug. 