title: Long-term drug treatment of obesity in a private practice setting.
abstract: This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over "desirable" bodyweight or body mass index > 27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15.9 months, and average weight loss at the last visit was 11.6 kg, or 11.7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16.5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patient fell by 0.750 mmol/L (29 mg/dL) and 0.937 mmol/L (83 mg/dL), respectively. Adverse events were modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.
authors.affiliation: Department of Internal Medicine, University of Wisconsin, Madison 53706-1571, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Atkinson
authors.forename: R C
authors.initials: RC
authors.lastname: Blank
authors.forename: D
authors.initials: D
authors.lastname: Schumacher
authors.forename: N V
authors.initials: NV
authors.lastname: Dhurandhar
authors.forename: D L
authors.initials: DL
authors.lastname: Ritch
mesh_terms: D000293:Adolescent; D000328:Adult; D001067:Appetite Depressants / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D004359:Drug Therapy, Combination; D005260:Female; D005277:Fenfluramine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy*; D010352:Patient Dropouts; D010645:Phentermine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011331:Private Practice
chemical_list: D001067:Appetite Depressants; D001786:Blood Glucose; D008055:Lipids; D005277:Fenfluramine; D010645:Phentermine