title: Randomized trial of lifestyle modification and pharmacotherapy for obesity.
abstract: BACKGROUND
  Weight-loss medications are recommended as an adjunct to a comprehensive program of diet, exercise, and behavior therapy but are typically prescribed with minimal or no lifestyle modification. This practice is likely to limit therapeutic benefits.
  
  
  METHODS
  In this one-year trial, we randomly assigned 224 obese adults to receive 15 mg of sibutramine per day alone, delivered by a primary care provider in eight visits of 10 to 15 minutes each; lifestyle-modification counseling alone, delivered in 30 group sessions; sibutramine plus 30 group sessions of lifestyle-modification counseling (i.e., combined therapy); or sibutramine plus brief lifestyle-modification counseling delivered by a primary care provider in eight visits of 10 to 15 minutes each. All subjects were prescribed a diet of 1200 to 1500 kcal per day and the same exercise regimen.
  
  
  RESULTS
  At one year, subjects who received combined therapy lost a mean (+/-SD) of 12.1+/-9.8 kg, whereas those receiving sibutramine alone lost 5.0+/-7.4 kg, those treated by lifestyle modification alone lost 6.7+/-7.9 kg, and those receiving sibutramine plus brief therapy lost 7.5+/-8.0 kg (P<0.001). Those in the combined-therapy group who frequently recorded their food intake lost more weight than those who did so infrequently (18.1+/-9.8 kg vs. 7.7+/-7.5 kg, P=0.04).
  
  
  CONCLUSIONS
  The combination of medication and group lifestyle modification resulted in more weight loss than either medication or lifestyle modification alone. The results underscore the importance of prescribing weight-loss medications in combination with, rather than in lieu of, lifestyle modification.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. wadden@mail.med.upenn.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.forename: Robert I
authors.initials: RI
authors.lastname: Berkowitz
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Womble
authors.forename: David B
authors.initials: DB
authors.lastname: Sarwer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Phelan
authors.forename: Robert K
authors.initials: RK
authors.lastname: Cato
authors.forename: Louise A
authors.initials: LA
authors.lastname: Hesson
authors.forename: Suzette Y
authors.initials: SY
authors.lastname: Osei
authors.forename: Rosalind
authors.initials: R
authors.lastname: Kaplan
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Stunkard
mesh_terms: D000328:Adult; D001067:Appetite Depressants / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases; D003131:Combined Modality Therapy; D003376:Counseling; D003503:Cyclobutanes / Q000009:adverse effects / Q000627:therapeutic use*; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D011615:Psychotherapy, Group; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015431:Weight Loss / Q000187:drug effects
chemical_list: D001067:Appetite Depressants; D003503:Cyclobutanes; D017367:Selective Serotonin Reuptake Inhibitors; C058254:sibutramine