Weight loss to treat urinary incontinence in overweight and obese women.
BACKGROUND
Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking.


METHODS
We randomly assigned 338 overweight and obese women with at least 10 urinary-incontinence episodes per week to an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (226 patients) or to a structured education program (112 patients).


RESULTS
The mean (+/-SD) age of the participants was 53+/-11 years. The body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) and the weekly number of incontinence episodes as recorded in a 7-day diary of voiding were similar in the intervention group and the control group at baseline (BMI, 36+/-6 and 36+/-5, respectively; incontinence episodes, 24+/-18 and 24+/-16, respectively). The women in the intervention group had a mean weight loss of 8.0% (7.8 kg), as compared with 1.6% (1.5 kg) in the control group (P<0.001). After 6 months, the mean weekly number of incontinence episodes decreased by 47% in the intervention group, as compared with 28% in the control group (P=0.01). As compared with the control group, the intervention group had a greater decrease in the frequency of stress-incontinence episodes (P=0.02), but not of urge-incontinence episodes (P=0.14). A higher proportion of the intervention group than of the control group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P<0.001), stress-incontinence episodes (P=0.009), and urge-incontinence episodes (P=0.04).


CONCLUSIONS
A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction. (ClinicalTrials.gov number, NCT00091988.)
Subak
Leslee L
LL
University of California, San Francisco, San Francisco, USA. subakl@obgyn.ucsf.edu
Wing
Rena
R
West
Delia Smith
DS
Franklin
Frank
F
Vittinghoff
Eric
E
Creasman
Jennifer M
JM
Richter
Holly E
HE
Myers
Deborah
D
Burgio
Kathryn L
KL
Gorin
Amy A
AA
Macer
Judith
J
Kusek
John W
JW
Grady
Deborah
D
D001521:Behavior Therapy; D015992:Body Mass Index; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000628:therapy*; D014549:Urinary Incontinence / Q000150:complications / Q000628:therapy*; D015431:Weight Loss