Benefits of Lifestyle Modification in the Pharmacologic Treatment of Obesity

Wadden, Thomas A.; Berkowitz, Robert I.; Sarwer, David B.; Prus-Wisniewski, Richard; Steinberg, Carrie

doi:10.1001/archinte.161.2.218

Cited by 276 publications

(208 citation statements)

References 34 publications

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“…54 However, interventions that combine pharmacotherapy with intensive lifestyle modification may induce losses of 8-12% of initial weight. 35,[55][56][57] Medication must be taken longterm to maintain weight loss. 56,58 Bariatric surgery is the most effective method of inducing and maintaining weight loses of 15% (gastric banding) to 25% (gastric bypass).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

2009

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OBJECTIVES: This review examines the results of randomized controlled trials in which behavioral weight loss interventions, used alone or with pharmacotherapy, were provided in primary care settings.DATA SOURCES: Literature search of MEDLINE, PubMed, Cochrane Systematic Reviews, CINAHL, and EMBASE (1950-present). Inclusion criteria for studies were: (1) randomized trial, (2) obesity intervention in US adults, and (3) conducted in primary care or explicitly intended to model a primary care setting. REVIEW METHODS:Both authors reviewed each study to extract treatment modality, provider, setting, weight change, and attrition. The CONSORT criteria were used to assess study quality. Due to the small number and heterogeneity of studies, results were summarized but not pooled quantitatively.

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Section: Discussionmentioning

confidence: 99%

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

2009

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“…Nonresponders were assumed to have regained 0.3 kg per month since leaving treatment. This conservative approach was developed by Wadden et al 21 and has been used on other large-scale studies. 22,23 Consistent with IOM recommendations, 3 we classified successful maintainers as those who maintained a weight loss of 5% or more of initial body weight.…”

Section: Statistical Analysesmentioning

confidence: 99%

Weight maintenance, behaviors and barriers among previous participants of a university-based weight control program

et al. 2007

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Objective: To examine weight loss maintenance among previous participants of a university-based behavioral weight management program and to compare behavioral strategies and perceived barriers between successful and unsuccessful maintainers. Method: Previous program participants (n ¼ 179) completed mailed surveys assessing current weight, weight control behaviors and perceived barriers to weight loss maintenance. Results: At 14.1 ± 10.8 months following completion of treatment, survey respondents were on average 12.6 ± 12.6 kg, or 11.3±10.7%, below baseline weight; 76.5% of respondents had successfully maintained weight, defined as maintaining a weight loss of at least 5% below baseline. Compared to unsuccessful maintainers, successful maintainers reported practicing four dietary and three physical activity weight control strategies more often and experiencing five barriers to healthy eating and exercise less often. After accounting for time since treatment and maximum weight loss while in treatment, the strongest correlates of successful weight loss maintenance were frequent exercise and perceived difficulty of weight management. Conclusions: Clinically meaningful weight loss maintenance was achieved by the majority of participants. Findings support the literature indicating that physical activity is one of the strongest predictors of successful weight loss maintenance. Findings also suggest that strategies to reduce the level of perceived effort required for long-term weight control may improve maintenance outcomes.

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“…There have been numerous studies conducted with all of the obesity drugs on the market, and the weight losses average about 5-10% of initial body weight at 6 months to 1 year. An exception was the Sibutramine Trial of Obesity Reduction and Maintenance (STORM) trial with sibutramine, 48 carried on in multiple sites in Europe, which achieved a loss of about 13% of initial body weight, and a study by Wadden et al 49 that demonstrated a weight loss of 16.5% at 1 year with sibutramine, rigid diet and lifestyle modification. However, the study by Wadden et al 49 and most of the sites in the STORM trial used very low-calorie diets to achieve a large initial weight loss, so the data are not comparable to those of other trials.…”

Section: Discussionmentioning

confidence: 99%

“…An exception was the Sibutramine Trial of Obesity Reduction and Maintenance (STORM) trial with sibutramine, 48 carried on in multiple sites in Europe, which achieved a loss of about 13% of initial body weight, and a study by Wadden et al 49 that demonstrated a weight loss of 16.5% at 1 year with sibutramine, rigid diet and lifestyle modification. However, the study by Wadden et al 49 and most of the sites in the STORM trial used very low-calorie diets to achieve a large initial weight loss, so the data are not comparable to those of other trials. Our data, and the data of Anchors,35 suggest that the weight losses achieved with phen-flu may be higher than those usually achieved with single obesity drugs currently on the market, and that this combination therapy may be justified.…”

Section: Discussionmentioning

confidence: 99%

Comparison of combinations of drugs for treatment of obesity: body weight and echocardiographic status

et al. 2006

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Background: Obesity treatment with single drugs produces weight losses of about 8-10% of initial body weight. Few studies of combinations of drugs for treating obesity have been published. The combination of phentermine, an adrenergic agent, and fenfluramine, a serotonergic agent, (phen-fen) produced weight losses of about 15% of initial body weight. Fenfluramine is no longer available because it was associated with cardiac valve lesions. Phentermine-fluoxetine (phen-flu) has been proposed as an alternative for phen-fen. Objective: To compare the efficacy of treatment and prevalence of cardiac valve abnormalities on phen-flu vs phen-fen. Design: Retrospective chart review of all patients treated for at least 3 months with phen-flu (N ¼ 97) to a random sample of patients treated with phen-fen (N ¼ 98) in the Clinical Nutrition Clinic at the University of Wisconsin. Comparison of echocardiograms in all patients treated solely with phen-flu (N ¼ 21) to a random sample of patients treated with phen-fen (N ¼ 47), and to a group of subjects never treated with obesity drugs (N ¼ 26). Results: With last observation carried forward analysis (LOCF), at 6 months of treatment the phen-fen patients lost 12.670.6% of baseline weight and phen-flu patients lost 9.070.6% (Po0.001). With completers analysis, there were no significant differences in weight loss as a percent of baseline weight at 6 months (14.470.6 vs 13.370.9%). LOCF decreases in body mass index (BMI) at 6 months were À5.3 and À3.6 kg/m 2 for phen-fen and phen-flu, respectively (Po0.001), and 6.270.3 vs 5.470.4 kg/m 2 , respectively, for the completers analysis (P -NS). Dropout rate at 6 months was higher in phen-flu subjects (44 vs 28%). In subjects without atherosclerosis of valves (presumably pre-existing), cardiac valve lesions occurred in eight of 38 phen-fen subjects and in none of 15 phen-flu subjects or 25 control subjects who had not been treated with drugs. Conclusions: The combination of phentermine and fluoxetine was not as effective as phen-fen, but was not associated with cardiac valve lesions. Longer term, larger scale studies of phen-flu are warranted.

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Benefits of Lifestyle Modification in the Pharmacologic Treatment of Obesity

Abstract: The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.

Cited by 276 publications

References 34 publications

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

Weight maintenance, behaviors and barriers among previous participants of a university-based weight control program

Comparison of combinations of drugs for treatment of obesity: body weight and echocardiographic status

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