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Lifestyle Change and Medication Helps Weight Loss

Breaking News - November 2005 - Week 5

(Nov 30, 2005)

Healthcare in  the News

-- Treatment with diet, exercise, and behavioral therapy along with a weight loss medication helps reduce weight better than medication alone, according to the New England Journal of Medicine.

Picture of people working out in a dance class

A new study shows that treatment with a lifestyle modification program of diet, exercise, and behavioral therapy when used in combination with the weight loss medication sibutramine (Meridia®) resulted in significantly greater weight loss among obese adults than treatment with the medication alone.

Obesity Fought on All Fronts

NIH [National Institutes of Health] is fighting the increasing problem of obesity in America by supporting research that will result in better treatments and therapies for weight loss and the prevention of obesity's associated diseases, such as type 2 diabetes, heart disease, and some forms of cancer,” says Dr. Elias A. Zerhouni, NIH director .

“Lifestyle modification should be the first line of treatment for obesity,” says Dr. Susan Yanovski, director of the Obesity and Eating Disorders Program for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and author of an accompanying editorial in the journal.

“But for obese adults who can’t lose enough weight to improve their health, medication used as an adjunct can help,” notes Dr. Yanovski.

“The take home message is that weight loss medications will be most effective when they are combined with a reduced calorie diet and increased physical activity,” says Dr. Thomas A. Wadden, lead author of the study. Dr. Wadden is a professor of psychology at the University of Pennsylvania School of Medicine.

“Weight loss medication used alone can produce some weight loss, but lifestyle modification treatment can help patients acquire skills to successfully make changes in their diet and physical activity,” explains Dr. Wadden.

A total of 224 obese adults ages 18 to 65 years participated in the one-year study.

Participants were randomly assigned to one of four groups: weight loss medication alone; lifestyle modification alone; weight loss medication plus lifestyle modification; and weight-loss medication plus brief physician-mediated therapy.

The researchers included the fourth treatment group to measure the effectiveness of weight-loss medication combined with brief lifestyle modification counseling delivered by primary care providers.

The researchers looked at this type of therapy as a possible model for delivering lifestyle modification therapy in the setting of primary care practice.

Lifestyle Changes Linked To Success

Participants in the lifestyle modification therapy group attended a total of 30 group meetings that each lasted 90 minutes.

During the meetings participants were instructed to complete and share weekly assignments, which included keeping detailed daily food and physical activity records.

Participants in the brief lifestyle modification counseling group met with primary care physicians eight times for 10 to 15 minute visits, where they were given homework assignments, which also included keeping daily food and activity records.

Participants in the weight-loss medication therapy alone group also met with primary care physicians eight times for 10 to 15 minute visits, but were not instructed to keep food or activity records and were provided only general information on diet and exercise.

Those participants in the combined therapy group received both the lifestyle modification therapy and the weight-loss medication. All groups were prescribed a 1200 to 1500 calorie diet and the same exercise plan.

After one year, patients in the weight-loss medication plus lifestyle group lost an average of more than 26 pounds - more than double the weight loss seen with medication alone (11 pounds).

In addition, 73 percent of participants in the combined therapy group lost 5 percent or more of their initial body weight, compared to 56 percent of participants in the brief therapy plus weight-loss medication group, 53 percent of participants in the lifestyle modification alone group, and 42 percent of participants in the weight-loss medication alone therapy group.

More than half or 52 percent of people in the combined therapy group lost 10 percent or more of their initial body weight compared to 29 percent of participants in the lifestyle modification alone group, 26 percent of participants in the brief therapy plus weight-loss medication group, and 26 percent of participants in the weight-loss medication alone group.

Interestingly, those participants in the combined therapy group who were most successful were those who frequently recorded their food intake.

Those participants with high adherence to food intake record keeping lost more than twice as much weight as those with low adherence (41.5 versus 17 pounds).

“Some people have questions about how they can do lifestyle modification,” says Dr. Wadden. “I think that a first step is to complete daily food logs. Food records help people become aware of their eating patterns and identifying areas for improvement.”

Physical Activity Is Key

Dr. Wadden adds that the second step to weight loss is to increase physical activity and one of the best ways to do that is to obtain a pedometer to count steps and gradually increase daily walking.

One limitation of the study is that it only included obese patients who were otherwise healthy and excluded obese patients with health problems possibly related to their obesity, such as hypertension, cardiovascular disease, cerebrovascular disease, kidney disease, liver disease, and diabetes.

Because many obese patients also have other conditions that can adversely affect their health, physicians should carefully monitor patients enrolled in weight-loss programs that include weight-loss medications.

The findings of the study are consistent with the NIH Obesity Clinical Guidelines, which recommend that weight loss medications be used in a supportive role to a comprehensive program of behavioral treatment, diet therapy, and increased physical activity.

The NIH Obesity Clinical Guidelines state that the most successful strategies for weight loss include calorie reduction, increased physical activity, and behavioral therapy designed to improve eating and physical activity habits.

The Guidelines also recommend that physicians prescribe a regimen of lifestyle therapy for at least six months before adding weight-loss medication to the regimen.

The study was supported by the NIDDK. Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


Benefits of Maintaining Weight Loss

While losing weight is difficult for many people, it is even more challenging to keep weight off.

Eighty percent to 85 percent of those who lose a large amount of weight regain it.

One theory about regaining lost weight is that people who decrease their caloric intake to lose weight experience a drop in their metabolic rate, making it increasingly difficult to lose weight over a period of months.

A lower metabolic rate may also make it easier to regain weight after a more normal diet is resumed. For these reasons, extremely low calorie diets and rapid weight loss are discouraged.

Losing no more than one to two pounds per week is recommended. Incorporating long-term lifestyle changes will increase the chance of successful long-term weight loss.

Weight loss to a healthy weight for a person’s height can promote health benefits such as lower cholesterol and blood sugar levels, lower blood pressure, less stress on bones and joints, and less work for the heart.

Thus, it is vital to maintain weight loss to obtain health benefits over a lifetime.

Keeping extra weight off requires effort and commitment, just as losing weight does.

Weight loss goals are reached by changes in diet, eating habits, exercise, and, in extreme circumstances, surgery.

The strategies that encourage weight loss also play an important role in maintenance.

Support systems used effectively during weight loss can contribute to weight maintenance.

A study conducted by the National Weight Control Registry found that people who lost weight and continued bi-monthly support group meetings for one year maintained their full weight loss. Study participants who did not attend support group meetings regained almost half of the weight.

Physical activity plays a vital role in maintaining weight loss. Studies show that even exercise that is not rigorous, such as walking and using stairs, has a positive effect.

Activity that uses 1,500 to 2,000 calories per week is recommended for maintaining weight loss.

Diet and exercise are vital strategies for losing and maintaining weight.

A study by the National Weight Control Registry found that nearly all of 784 study participants who had lost at least 30 pounds, and had maintained that loss for one year or longer, used diet and exercise to not only lose the weight, but also to maintain the weight loss.

Once the desired weight has been reached, the gradual addition of about 200 calories of healthy, low-fat food to daily intake may be attempted for one week to see if weight loss continues.

If weight loss does continue, additional calories of healthy foods may be added to the daily diet until the right balance of calories to maintain the desired weight has been determined.

It may take some time and record keeping to determine how adjusting food intake and exercise levels affect weight.

Continuing to use behavioral strategies can help maintain weight. Be aware of eating as a response to stress and use exercise, activity, or meditation to cope instead of eating.

A return to old habits does not mean failure. Paying renewed attention to dietary choices and exercise can help sustain behaviors that maintain weight loss.

Identifying situations such as negative moods and interpersonal difficulties and incorporating alternative methods of coping with such situations rather than eating can prevent relapses to old habits.

Always consult your physician for a diagnosis.


Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Obesity Association

CDC on Overweight and Obesity

Centers for Disease Control and Prevention (CDC)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

National Weight Control Registry

National Women's Health Information Center

NIH Obesity Clinical Guidelines

New England Journal of Medicine

US Surgeon General on Overweight and Obesity

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