Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial.
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.
Wadden
T A
TA
Department of Psychiatry, University of Pennsylvania School of Medicine, 3600 Market St, Suite 738, Philadelphia, PA 19104, USA. Wadden@mail.med.upenn.edu
Berkowitz
R I
RI
Sarwer
D B
DB
Prus-Wisniewski
R
R
Steinberg
C
C
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
D001067:Appetite Depressants; D003503:Cyclobutanes; C058254:sibutramine