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Clinical Question:
In obese patients, what is the best strategy to loss weight?
Bottom Line:
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.
Reference:
Randomized Trial of Lifestyle Modification and Pharmacotherapy for
ObesityThomas A. Wadden, Ph.D., Robert I. Berkowitz, M.D., Leslie G. Womble,
Ph.D., David B. Sarwer, Ph.D., Suzanne Phelan, Ph.D., Robert K. Cato, M.D.,
Louise A. Hesson, M.S.N., Suzette Y. Osei, M.D., Ph.D., Rosalind Kaplan,
M.D., and Albert J. Stunkard, M.D. NEJM, Volume 353:2111-2120 November 17,
2005,Number 20
Study Design:
Randomized controlled trial
Setting:
Population-based
Synopsis:
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. 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. 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). |