Medication Works Best With Diet and Exercise

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Randomized trial of lifestyle modification and pharmacotherapy for obesity, by T.A. Wadden and colleagues. N Engl J Med 353:2111–2120, 2005.

What is the problem and what is known about it so far?

Weight loss drugs such as sibutramine (Meridia, Abbott Laboratories) and orlistat (Xenical, Roche) are supposed to be taken as part of an overall treatment plan that includes diet, exercise, and behavioral changes. But in real life, primary care doctors often just prescribe the drugs and drop the ball on the other parts of treatment. Not surprisingly, people often fail to drop weight and keep it off with medication alone.

Why did the researchers do this particular study?

The researchers wanted to compare the effectiveness of medication alone, diet and lifestyle changes alone, and the two approaches in combination. They predicted that the combination would work better than either approach.

Who was studied?

The study included 224 obese adults, ranging from 18 to 65 years old. There were 180 women and 44 men who were overweight or obese. None of the participants had diabetes, disease of the heart and blood vessels, or other major medical problems.

How was the study done?

Participants were put into four different treatment groups. Fifty-five people took 15 mg of sibutramine each day; 55 people attended weekly group meetings that focused on diet, exercise, and healthful lifestyle changes; 60 people took sibutramine and attended weekly group meetings; 54 people took sibutramine and had brief counseling from primary care doctors.

What did the researchers find?

Over a one-year period, participants who received the combination of medication and group visits lost more weight than those who had medication or lifestyle changes alone. People who had the combination lost an average of 27 pounds (12.1 kg), while those treated with drug therapy alone lost an average of 11 pounds (5 kg) and those who had weekly lifestyle group visits lost an average of 15 pounds (6.7 kg). People who took sibutramine and had brief therapy lost an average of 16.5 pounds (7.5 kg).

What were the limitations of the study?

Researchers don't know what parts of the lifestyle changes are responsible for weight loss. Several patients dropped out of the study for a variety of reasons, which could affect the results. A study for a longer time period, such as two years, might find different results.

What are the implications of the study?

Medication works best when used in addition to lifestyle changes that include diet, exercise, and other healthful choices. But even a brief counseling session by a primary care doctor is better than just prescribing medication alone.

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