Nov. 16, 2005 -- Diet drugs can help you lose weight, and so can cutting cal
Nov. 16, 2005 -- Diet drugs can help you lose weight, and so can cutting calories and making other lifestyle changes. But combining the two approaches is far more effective than either approach alone, new research shows.
In the study, obese people who modified their eating and exercise habits and took the drug Meridia lost far more weight than people who relied on either lifestyle modification or medication.
"We found that a combination of the two approaches produced approximately twice the weight loss of either intervention used alone," says researcher Thomas A. Wadden, PhD.
The study appears in the Nov. 17 issue of The New England Journal of Medicine.
Many Rely on Drugs Alone
There are two FDA-approved prescription weight loss drugs being sold in the U.S.: Abbott Laboratories' Meridia and Roche's Xenical. Meridia works by suppressing appetite, while Xenical works in the digestive system to block the absorption of fats.
Both drugs are intended for use as part of a comprehensive program that includes diet, exercise, and behavior therapy. But all too often patients are sent home with prescriptions alone, Wadden says.
"Certainly, the doctors who prescribe these medications recommend that their patients cut calories and increase physical activity, but these recommendations may be left at the office door," Wadden tells WebMD.
In an effort to better understand the effectiveness of the different treatment approaches, Wadden and colleagues followed 224 obese men and women on different weight loss regimens for a year.
One group was prescribed standard doses of Meridia with scheduled 10-15 minute office visits with primary care providers. They received minimal lifestyle recommendations, which consisted of an initial pamphlet and "general encouragement." A second group did not take the drug but did participate in an intensive group lifestyle modification program. These patients attended 30, 90-minute group education and support sessions over the course of a year. They also kept daily records of the foods they ate and their physical activity.
A third group received a combination of the drug, brief visits with a primary care provider, and intensive lifestyle modification group sessions similar to the second group. A fourth group took the diet drug and received additional counseling during regularly scheduled office visits. They also kept food and exercise journals, which were reviewed during their office visits with the primary care provider.
This fourth group was added, Wadden says, to see if doctors can provide enough lifestyle counseling to have an impact on weight loss within the confines of the typical brief office visit.
Diet and Lifestyle Changes Get Best Results
At the end of a year, the patients who took the diet drug and participated in the intensive lifestyle modification program lost the most weight, averaging 26.6 pounds.
The Meridia plus brief, doctor-delivered counseling group lost 16.5 pounds. The group that participated in the intensive program but took no Meridia lost 14.7 pounds, and the Meridia-only treatment group lost 11 pounds.
Wadden says drugs and lifestyle modification complement each other because they address different issues. Support and education programs teach people the tools they need to achieve a healthy weight and the drugs help them take in fewer calories.
Can Doctors Do It?
The findings also suggest that doctors can provide meaningful lifestyle counseling, even during rushed office visits, Wadden adds. Having patients keep daily food and exercise journals, and helping them develop a weight loss plan that met their individual needs were two important components of this counseling.
But Howard Eisenson, MD, who has been on both sides of the issue, is skeptical.
He tells WebMD that he didn't have a lot of success getting patients to lose weight as a private practice family doctor. But he has seen plenty of success stories in his current job as director of Duke University Medical Center's well-known Diet and Fitness Center.
"We have a team approach that includes dietitians, fitness specialists, and behavioral therapists in addition to physicians," he says. "These are people who are very important to the process. I think the physician's role is primarily to be a cheerleader -- to show confidence in the patient's ability to make lasting changes and to follow up."
