Long-term medication use and weight loss maintenance: an observational study

Lifestyle modification for the management of obesity

Several expert panels have recommended that obese individuals attempt to lose 10% of their initial body weight through a combination of diet, physical activity, and behavior therapy (frequently referred to as lifestyle modification). This article reviews the short-and long-term results of lifestyle modification and methods to improve them. Randomized controlled trials were examined that compared different diet and activity interventions for inducing and maintaining weight loss. Studies that compared different methods of providing lifestyle modification, including on-site vs. Internet-based delivery, also were examined. A comprehensive lifestyle modification program was found to induce a loss of approximately 10% of initial weight in 16 to 26 weeks of group or individual treatment, delivered on-site. Comprehensive Internet-based programs induced a loss of approximately half this size. Patients' consumption of portion-controlled diets, including liquid meal replacements, was associated with significantly greater short-term weight loss than was the consumption of isocaloric diets comprised of conventional foods. Factors associated with long-term weight control included continued patient-practitioner contact (whether on-site or by e-mail), high levels of physical activity, and the long-term use of pharmacotherapy combined with lifestyle modification. In summary, lifestyle modification induces clinically significant weight loss that is associated with the prevention or amelioration of cardiovascular risk factors.

Pharmacotherapy of obesity

Whereas several drugs to treat most other chronic conditions have been developed over the last 30 years, progress in pharmacologic therapy for obesity has been slow. The record of drug treatment for obesity partly explains this phenomenon and is of concern. Several compounds have been withdrawn when severe side effects have been discovered. The lack of scientifically developed safe and effective antiobesity drugs has opened the gates for an enormous number of commercial products that make vast sums of money, but have no scientific evidence backing their efficacy. This pattern is seen in both developed and developing countries. summarizes some of the presently accepted, scientifically evaluated antiobesity drugs. At present, orlistat and sibutramine are the only two major drugs used almost worldwide.

Success rate of Orlistat in primary-care practice is limited by failure to follow prescribing recommendations: the referral letter content vs clinical reality

Numerous referrals to our Obesity Unit state that 'treatment with Orlistat did not work'. This surprised us, since Orlistat has been well documented to result in long-term sustained moderate weight loss. A simple questionnaire to 70 such patients, however, revealed that in many cases the referral physician had not observed basic rules and regulations, nor given appropriate information on Orlistat use.