A community-engaged randomized controlled trial assessing the effectiveness of a weight loss aid in reducing the body burden of persistent organic pollutants.

Background: Exposure to persistent organic pollutants (POPs) can impact human health and have multigenerational consequences. These chemicals are particularly concerning because they accumulate in adipose tissue and are eliminated slowly, leading to prolonged internal exposure and potential long-term health effects. Methods: To assess whether a weight loss aid could reduce the body burden of POPs, we conducted a community-engaged randomized, quadruple-blind, placebo-controlled trial in a population highly exposed to a brominated flame retardant, polybrominated biphenyl (PBB). Blood samples, anthropometric data, and other study assessments were collected at baseline, 3 months, and 6 months. The aim was to determine if orlistat use resulted in weight loss accompanied by a decrease in concentrations of PBB and other persistent chemicals (PBDEs, PCBs, and p,p'-DDE). Results: Of the 100 participants initially enrolled, 89 (placebo, n=45; orlistat, n=44) completed the six-month study. We found greater weight loss in the orlistat group, losing 2 kg more on average compared to the placebo group (Month 6 group difference: -1.99, 95% CI: -3.81, -0.18). POP models showed no statistically significant group differences, or a reduction in serum concentrations over the six months. Conclusions: This study began because community members raised questions about how to eliminate PBB from the body. Participants' dedication was evident by the low attrition rate (11%). A six-month orlistat intervention did not result in lower serum concentrations of PBB or other POPs. Further research is needed to determine effective ways to decrease the body burden of this class of chemicals.