title: Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial.
abstract: BACKGROUND
  Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians. This practice is likely to be associated with suboptimal weight loss.
  
  
  METHODS
  This 1-year, randomized trial compared the effects of sibutramine hydrochloride used alone (ie, the drug-alone group) to sibutramine plus group lifestyle modification, prescribed with either a 5021- to 6276-kJ/d diet (1200-1500-kcal/d diet) (ie, the drug-plus-lifestyle group) or, for the first 4 months, a 4184-kJ/d diet (1000-kcal/d diet (ie, drug-plus-lifestyle with a portion-controlled diet [the combined treatment] group). Participants were 53 women with a mean (+/-SD) age of 47.2 +/- 9.8 years and weight of 101.3 +/- 9.7 kg. At baseline, they reported the number of pounds they expected to lose at the end of treatment.
  
  
  RESULTS
  At month 12, patients treated with the drug alone lost (mean +/- SD) 4.1% +/- 6.3% of their initial body weight compared with significantly (P<.05) larger losses in the drug-plus-lifestyle group of 10.8% +/- 10.3% and the combined treatment group of 16.5% +/- 8.0%. Women in the 2 lifestyle groups achieved a significantly (P<.05) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight, health, appearance, and self-esteem (P<.05 for all). Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly (P<.05 for all).
  
  
  CONCLUSIONS
  The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.
authors.affiliation: Department of Psychiatry, University of Pennsylvania School of Medicine, 3600 Market St, Suite 738, Philadelphia, PA 19104, USA. Wadden@mail.med.upenn.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Wadden
authors.forename: R I
authors.initials: RI
authors.lastname: Berkowitz
authors.forename: D B
authors.initials: DB
authors.lastname: Sarwer
authors.forename: R
authors.initials: R
authors.lastname: Prus-Wisniewski
authors.forename: C
authors.initials: C
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D001067:Appetite Depressants / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003503:Cyclobutanes / Q000627:therapeutic use*; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D006126:Group Processes; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy*; D010349:Patient Compliance; D017060:Patient Satisfaction; D015431:Weight Loss
chemical_list: D001067:Appetite Depressants; D003503:Cyclobutanes; C058254:sibutramine