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Three-Tier Strategy Aids Weight Loss.

WASHINGTON -- An aggressive weight loss program that combines diet, drug therapy, and behavioral modification can improve patient outcomes significantly at 1 year, compared with a single- or even a dual-modality approach, Dr. Robert I. Berkowitz said at a meeting sponsored by the American Obesity Association.

He and his associates at the University of Pennsylvania, Philadelphia, randomly assigned 20 patients to sibutramine (Meridia) alone, 17 to sibutramine and behavioral modification therapy, and 18 to those modalities plus a daily diet of 1,000 calories.

After 6 months, patients using all three modalities had lost 17% of their initial body weight, compared with 5% with medication and 10% with the drug plus behavioral therapy. At 1 year, the three-modality group maintained a 16% weight loss.

"The different treatments we have to offer may in fact be additive. We're pretty excited by it," Dr. Berkowitz said.

Patients managed on sibutramine alone in clinical trials for its Food and Drug Administration approval had lost an average of 7%-8% of their initial body weight at 1 year. Other studies have shown that behavioral modification therapy alone helped patients lower their initial body weight by 9% in 20 weeks. Without further treatment, patients maintained a loss of about 5% at 1 year.

Patient expectations pose a serious obstacle to such an intensive weight loss program, Dr. Berkowitz said. "It's a hard sell to convince patients" that the effect is not just a result of the drug therapy.

And physicians should set realistic goals for their patients in terms of short-term weight loss. It's not uncommon to hear health care colleagues express disappointment that patients have lost only 10% of their body weight. "In fact, that's quite a good goal to achieve," he said.

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Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Dec 1, 2000
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