Researchers at the University of Pennsylvania Medical Center report today in the Archives of Internal Medicine ( January 22, 2001) that obese women lost an average 24.4 pounds (10.8 percent of their body weight) in one year, when they used the weight loss medication MERIDIA in combination with a comprehensive lifestyle modification program that included diet and exercise -- compared to a loss of only 8.4 pounds (4.1%) for women treated by medication alone.
Participants in both groups were prescribed 10-to-15 milligrams per day of MERIDIA, a weight loss medication manufactured by the Knoll Pharmaceutical Co. They were also told to limit their daily food intake to 1,200-to-1,500 calories, and to exercise four to five times a week. For the first five months, those in the lifestyle modification program also attended weekly group sessions in which they learned to keep food and activity records, to plan their meals and snacks, and to control situations associated with problem eating.
Women in the group that received only medication had 10 brief physician visits over the year, during which a doctor monitored their health but did not provide detailed instruction in lifestyle modification. These participants received general advice and support, comparable to treatment that would be provided by most primary care doctors.
"The results clearly demonstrate the benefits of combining medication with lifestyle modification," said Thomas A. Wadden, Ph.D., director of the Weight and Eating Disorders Program at the University of Pennsylvania and the study's lead author.
"These medications may decrease the desire to eat by reducing hunger and cravings or by increasing feelings of fullness; they modify internal (physiological) factors that control eating," Wadden said. "Lifestyle modification, by contrast, helps people control their external environment by teaching them to reduce portion sizes, avoid fast-food restaurants, store foods out of sight, and plan meals and snacks in advance. Weight loss medications are not a substitute for an individual's own efforts to improve eating and activity habits." A third group of women was also provided medication combined with lifestyle modification. But during the first 4 months, members of this group limited their food intake to 1000 calories a day, consisting of four servings daily of a nutritional supplement (OPTIFAST 800, manufactured by the Novartis Nutrition Co.) and a frozen food entrée for dinner.
At the end of the year, these women had lost an average 35.5 pounds (16.5% of their initial weight) -- representing "outstanding weight loss," according to Robert I. Berkowitz, M.D., Medical Director of the Weight and Eating Disorders Program and co-author of the study. "The next step is to determine whether continuing the medication long-term will help patients maintain these large weight losses," he said.
The study also found that participants had highly unrealistic weight loss expectations.
Before treatment, women in all three groups reported that they expected to lose the equivalent of 25% of their initial body weight, even after investigators had told them to expect a loss of only 5%-15%. The participants treated by medication alone achieved by far the smallest percentage of their expected weight loss and were the least satisfied with changes in their weight, health, and appearance. Those who received the combination approach were significantly more satisfied with their outcomes, but were only moderately satisfied over all.
"We have to help people realize that a loss of five to 10 percent of their initial body weight is a real therapeutic success," Wadden said. "Most overweight women won't look like Cindy Crawford after treatment, but they can improve their health and vitality by losing those first 10-to-20 pounds."