Finding the Right Combo for Losing Weight
Oct. 05, 2011 - Trying to lose those extra pounds? You may be more successful if you choose a weight-loss program that focuses on changing habits and behaviors. And if it also includes weight-loss medications, that's even better.
That's the conclusion of a review of 58 clinical trials involving overweight adults. Some of the trials examined how behavior change affects weight loss; others looked at the effectiveness of behavior change coupled with weight-loss medications like orlistat (Alli or Xenical).
"We found behaviorally based weight loss programs are generally effective for weight loss," says Erin LeBlanc, M.D., at Kaiser Permanente Center for Health Research in Portland, Ore.
The U.S. Preventive Services Task Force (USPSTF) asked Dr. LeBlanc and her colleagues to review the studies to help the agency decide whether its weight-loss guidelines needed to be updated.
In 2003, the USPSTF recommended that doctors screen all adults for obesity and offer behavioral interventions for those who with a body mass index (BMI) of 30 or above. A BMI in that range is considered obese.
The researchers found that behavior-based weight loss programs helped people lose an average of 6.6 more pounds over 12 to 18 months than if they had attempted to slim down without a program. People who attended 12 to 26 intervention sessions during the first year on such programs lost nine to 15 pounds; those who did not attend the sessions lost little or no weight.
Those who enrolled in a behavior-change program and received the weight-loss drug orlistat lost 11 to 22 pounds (about 8 percent of their starting weight) in the first 12 months. In comparison, people who had taken a placebo while they were on a weight-loss program lost an average of seven to 13 pounds.
The behavior-change programs typically offered group classes and/or individual counseling. The programs also encouraged participants to exercise, set goals, and monitor their progress.
Some of the studies were difficult to evaluate, Dr. LeBlanc says. Those that included weight-loss medication had high dropout rates because of medication side effects. And those studies often didn't include enough participants to accurately assess the side effects. (The FDA noted last year that orlistat carried a rare but severe risk for liver injury.)
Although participants who took orlistat lost more weight than those who did not, it's possible that they regained the weight after they stopped taking the drug. "We don't know what happens when they quit," says Dr. LeBlanc.
Frank Greenway, M.D., at Pennington Biomedical Research Center in Baton Rouge, La., says he wasn't impressed with the study results.
Although a small percent of people may lose weight in the short term, few can keep it off, he says.