We always recommend lifestyle modification when we prescribe weight-loss medications, but the intensity, and therefore the benefit, of such modification is usually minimal. In this federally funded 1-year study, investigators randomized 224 subjects (age range, 18–65; 80% women; body-mass index, 30–45 kg/m2) to one of four groups:
All participants were instructed to maintain 1200–1500 kcal/day diets. The group lifestyle modification consisted of 30 90-minute sessions during the first 40 weeks of the study, and PCP counseling consisted of 8 15-minute individual visits during the study. A total of 185 subjects completed the study (81%–85% of each group). In an intent-to-treat analysis at 1 year, subjects who received sibutramine alone, group lifestyle modification sessions alone, sibutramine plus PCP counseling, and sibutramine plus group lifestyle modification sessions lost a mean of 5 kg, 6.7 kg, 7.5 kg, and 12.1 kg, respectively. Weight loss in the group that received sibutramine plus group lifestyle modification sessions was significantly greater than weight loss in the other three groups.
This study is notable for its low dropout rate and the relatively large weight losses that were maintained for a year. PCP counseling is very time consuming and was associated with little incremental weight loss over sibutramine alone. Group lifestyle modification sessions are effective both alone and with sibutramine, but they would be difficult to arrange for many patients and currently are not reimbursed by many health care plans.
Reference:
Wadden TA et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 2005 Nov 17; 353:2111-20.