Twenty-seven women were identified as PPL positive and assigned to the orlistat + diet group (18 subjects) or the control group (9) (mean [SD] age, 45.9 [2.3] years; mean [SD] weight, 87.4 [2.5] kg; mean [SD] BMI, 36.0 [0.8] kg/m2). Treatment with orlistat + diet was associated with significantly greater changes from baseline compared with controls in WC (P= 0.003), fasting and postprandial serum TG levels (P = 0.012 and P < 0.001, respectively), FPI level (P = 0.001), and HOMA-IR index (P < 0.001). Logistic regression analysis found that 12 weeks of treatment with orlistat + diet was associated with a numeric, but statistically non-significant, 4.1-fold change in PPL, which was independent of reductions from baseline in weight and WC. Neither treatment was associated with significant changes from baseline in BAR. The prevalences of gastrointestinal symptoms previously found to be related to orlistat use were statistically similar between the orlistat + diet and control groups (9 [50.0%] vs 3 [33.3%] subjects).