title: Weight loss to treat urinary incontinence in overweight and obese women.
abstract: 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.)
authors.affiliation: University of California, San Francisco, San Francisco, USA. subakl@obgyn.ucsf.edu
authors.forename: Leslee L
authors.initials: LL
authors.lastname: Subak
authors.forename: Rena
authors.initials: R
authors.lastname: Wing
authors.forename: Delia Smith
authors.initials: DS
authors.lastname: West
authors.forename: Frank
authors.initials: F
authors.lastname: Franklin
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Creasman
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Deborah
authors.initials: D
authors.lastname: Myers
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Burgio
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gorin
authors.forename: Judith
authors.initials: J
authors.lastname: Macer
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Deborah
authors.initials: D
authors.lastname: Grady
mesh_terms: 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