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December 18, 1996, Vol 276, No. 23 >
ARTICLE | December 18, 1996

Long-term Pharmacotherapy in the Management of Obesity: Title and subTitle BreakNational Task Force on the Prevention and Treatment of Obesity FREE

[+] Author Affiliations

A complete list of members of the National Task Force on the Prevention and Treatment of Obesity and their financial disclosures appear at the end of this article.

Reprints: Susan Zelitch Yanovski, MD, Weight-Control Information Network, 1 WIN WAY, Bethesda, MD 20892-3665.


JAMA. 1996;276(23):1907-1915. doi:10.1001/jama.1996.03540230057036
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References

Objectives.  —To examine the rationale for long-term use of medications in the management of obesity, to provide an overview of published scientific information on their safety and efficacy, and to provide guidance to patients and practitioners regarding risks and benefits of treatment.

Data Sources.  —Original reports and reviews obtained through electronic database searches on anorexiant drugs supplemented by a manual search of bibliographies.

Study Selection.  —English-language articles that discussed the role of medications in the treatment of human obesity, and studies that evaluated their safety and efficacy for a minimum of 24 weeks.

Data Extraction.  —Studies were reviewed by experts in the fields of nutrition, obesity, and eating disorders to evaluate study design and the validity of authors' conclusions.

Data Synthesis.  —The long-term use of medications in the management of obesity is consistent with the current consensus that obesity responds poorly to short-term interventions. Net weight loss attributable to medication is modest, ranging from 2 to 10 kg, but patients taking active drug are more likely to lose 10% or more of initial body weight. Weight loss tends to reach a plateau by 6 months. Weight remains below baseline throughout treatment, although some studies show partial weight regain despite continued drug therapy. Most adverse effects are mild and self-limited, but rare serious outcomes have been reported.

Conclusions.  —Pharmacotherapy for obesity, when combined with appropriate behavioral approaches to change diet and physical activity, helps some obese patients lose weight and maintain weight loss for at least 1 year. There is little justification for the short-term use of anorexiant medications, but few studies have evaluated their safety and efficacy for more than 1 year. Until more data are available, pharmacotherapy cannot be recommended for routine use in obese individuals, although it may be helpful in carefully selected patients.

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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
References 11-19, 37-39, 42, 43, 46, 48-53, 57-62, 64-66. A table summarizing these studies is available on the World Wide Web at http://www.niddk.nih.gov/NutritionDocs.html/LtStudy/table.htm.
2 +
Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL.  Increasing prevalence of overweight among US adults . JAMA . 1994;;272:205-211.
3 +
Pi-Sunyer FX.  Medical hazards of obesity . Ann Intern Med . 1993;;110:655-660.
4 +
Manson JE, Willett WC, Stampfer MJ, et al.  Body weight and mortality among women . N Engl J Med . 1995;;333:677-685.
5 +
McGinnis JM, Foege WH.  Actual causes of death in the United States . JAMA . 1993;;270:2207-2212.
6 +
Wolf AM, Colditz GA.  The cost of obesity: the US perspective . Pharmacoeconomics . 1994;;5( (suppl 1) ):34-37.
7 +
Hearings Before the Subcommittee on Regulation, Business Opportunities, and Energy of the House Committee on Small Business. Testimony of Janet D. Steiger, chairman, Federal Trade Commission. March 26, 1990.
8 +
National Institutes of Health Technology Assessment Conference Panel.  Methods for voluntary weight loss and control . Ann Intern Med . 1993;;119:764-770.
9 +
Bray GA.  Use and abuse of appetite-suppressant drugs in the treatment of obesity . Ann Intern Med . 1993;;119:707-713.
10 +
Stunkard AJ.  The current status of treatment for obesity in adults . In: Stunkard AJ, Stellar E, eds. Eating and Its Disorders . New York, NY: Raven Press; 1984;:157-173.
11 +
Atkinson RL, Hubbard VS.  Report on the NIH Workshop on Pharmacologic Treatment of Obesity . Am J Clin Nutr . 1994;;60:153-156.
12 +
Weintraub M.  Long-term weight control: the National Heart, Lung, and Blood Institute funded multi-modal intervention study . Clin Pharmacol Ther . 1992;;51:581-585.
13 +
Weintraub M, Sundaresan PR, Maddan M, et al.  Long-term weight control study I (weeks 0-34): the enhancement of behavior modification, caloric restriction, and exercise by fenfluramine plus phentermine versus placebo . Clin Pharmacol Ther . 1992;;51:586-594.
14 +
Weintraub M, Sundaresan PR, Schuster B, et al.  Long-term weight control study II (weeks 34-104): an open-label study of continuous fenfluramine plus phentermine versus targeted intermittent medication as adjuncts to behavior modification, caloric restriction, and exercise . Clin Pharmacol Ther . 1992;;51:595-601.
15 +
Weintraub M, Sundaresan PR, Schuster B, Moscucci M, Stein EC.  Long-term weight control study III (weeks 104-156): an open-label study of dose adjustment of fenfluramine and phentermine . Clin Pharmacol Ther . 1992;;51:602-607.
16 +
Weintraub M, Sundaresan PR, Schuster B, et al.  Long-term weight control study IV (weeks 156-190): the second double-blind phase . Clin Pharmacol Ther . 1992;;51:608-614.
17 +
Weintraub M, Sundaresan PR, Schuster B, Averbuch M, Stein EC, Byrne L.  Long-term weight control study V (weeks 190-210): follow-up of participants after cessation of medication . Clin Pharmacol Ther . 1992;;51:615-618.
18 +
Weintraub M, Sundaresan PR, Cox C.  Long-term weight control study VI: individual participant response patterns . Clin Pharmacol Ther . 1992;;51:619-633.
19 +
Weintraub M, Sundaresan PR, Schuster B.  Long-term weight control study VII (weeks 0-210): serum lipid changes . Clin Pharmacol Ther . 1992;;51:634-641.
20 +
Weintraub M.  Long-term weight control study: conclusions . Clin Pharmacol Ther . 1992;;51:642-646.
21 +
Statement of Dr Bruce Stadel. In: Food and Drug Administration Endocrinologic and Metabolic Drugs Advisory Committee Meeting Condensed Transcript and Concordance . Washington, DC: SAG Corp: September 28, 1995;:261-268.
22 +
Kanders BS, Blackburn GL.  Reducing primary risk factors by therapeutic weight loss . In: Wadden TA, van Itallie TB, eds. Treatment of the Seriously Obese Patient . New York, NY: Guilford Press; 1992;: 213-230.
23 +
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