Investigators at The Weight and Eating Disorders Program at the University of Pennsylvania Medical Center have found an effective new method of combining weight loss medication with diet and exercise counseling, according to a study published in the most recent issue* of Obesity Research. Twenty-six obese women were treated for one year with the medications fenfluramine and phentermine (i.e., fen-phen), which were combined with a program of lifestyle modification delivered during either 10 brief individual physician visits or 32 lengthy group meetings. Patients in both groups lost an average of approximately 30 pounds, from a starting weight of 215 pounds. "Results of this preliminary study suggest that physicians can effectively treat their overweight patients by the combination of medication and brief lifestyle counseling," said lead author Thomas A. Wadden, PhD, director of Penn's Weight and Eating Disorders Program. "We were surprised but pleased to find that medication plus brief physician counseling was as effective as medication plus more intensive group behavior modification. These very encouraging results await replication in a larger study."
Wadden's study was designed as a follow-up to Dr. Michael Weintraub's 1992 report that popularized the fen-phen combination for weight management. In that study, patients who received medication in combination with 14 group lifestyle modification sessions lost an average of 31 pounds during an initial 34 weeks of treatment. "We wondered whether the group behavior modification sessions were necessary for successful weight loss," said Wadden, "since we knew that most physicians would not be able to provide such group treatment." Thus, Wadden and his colleagues developed a new protocol in which patients received diet and exercise counseling from a physician during 10 brief office visits, spaced at monthly to bi-monthly intervals. The physician instructed patients in lifestyle modification using the LEARN Program for Weight Control, a manual developed by psychologist Kelly Brownell at Yale University. Patients who were treated by the combination of medication and group lifestyle modification received the same treatment materials which they reviewed with nutritionists during 32, 75-minute group sessions during the year.
"The results of the physician counseling were very successful," noted co-author Robert I. Berkowitz, MD, assistant professor of psychiatry at Penn, who treated the patients. "We hope that doctors in primary care practice will be able to achieve comparable results by using an approach similar to the one that we tested."
Previous studies have shown that the combination of weight loss medication and lifestyle modification is superior to treatment by medication alone. Two studies found that the combination produced weight losses one and one half to two times greater than those produced by medication alone. "Weight loss medications make it easier for overweight individuals to eat a low-fat, low-calorie diet," said Wadden. "But people will achieve the best results if they combine medication with their own efforts to change eating and exercise habits." In the present study, the more often patients kept daily diet diaries, the more weight they tended to lose.
Women in this study averaged 47 years of age, and all were free of major health problems. None of the participants experienced significant health complications. Wadden cautioned that weight loss medications should be used only by persons who are substantially overweight and are under the care of a physician. "We hope that the results of this study will help physicians achieve the best results with their patients," he said.
* Vol. 5, No. 3, May, 1997
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