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Diet, Exercise, Therapy, Medication and Daily Weigh-in Equals Weight Loss...whew!

Nov. 17, 2005 - Two new studies have advice for losing weight. One says diet, exercise and behavioral therapy used with a weight loss medication produced much greater weight loss by obese adults than just taking the medicine. And, another study says it helps to lose weight if you get on the scale everyday. So there you have it – exercise, diet, therapy, diet pill and a daily weigh-in. Certainly all that burns enough calories for anyone to shed pounds.

The study using the weight loss medication used the drug sibutramine (Meridia).

It was conducted by researchers from the University of Pennsylvania and appears in the November 17, 2005 issue of The New England Journal of Medicine. It was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health (NIH).

(See study on daily weighing below.)

“NIH is fighting the increasing problem of obesity in America by supporting research that will result in better treatments and therapies for weight loss and the prevention of obesity's associated diseases, such as type 2 diabetes, heart disease, and some forms of cancer,” says NIH Director Elias A. Zerhouni, M.D.

“Lifestyle modification should be the first line of treatment for obesity,” says Susan Yanovski, M.D., director of the Obesity and Eating Disorders Program for NIDDK, and author of an accompanying editorial in the journal. “But for obese adults who can’t lose enough weight to improve their health, medication used as an adjunct can help.”

“The take home message is that weight loss medications will be most effective when they are combined with a reduced calorie diet and increased physical activity,” says Thomas A. Wadden, Ph.D., Professor of Psychology in the Department of Psychiatry at the University of Pennsylvania School of Medicine, and lead author of the study. “Weight loss medication used alone can produce some weight loss, but lifestyle modification treatment can help patients acquire skills to successfully make changes in their diet and physical activity.”

A total of 224 obese adults aged 18 to 65 years participated in the one-year study.

Participants were randomly assigned to one of four groups: 1. weight loss medication alone; 2. lifestyle modification alone; 3. weight loss medication plus lifestyle modification; and 4. weight-loss medication plus brief physician-mediated therapy. The researchers included the fourth treatment group to measure the effectiveness of weight-loss medication combined with brief lifestyle modification counseling delivered by primary care providers. The researchers looked at this type of therapy as a possible model for delivering lifestyle modification therapy in the setting of primary care practice.

Participants in the lifestyle modification therapy group attended a total of 30, 90-minute group meetings. During the meetings participants were instructed to complete and share weekly assignments, which included keeping detailed daily food and physical activity records.

Participants in the brief lifestyle modification counseling group met with primary care physicians eight times for 10 to 15 minute visits, where they were given homework assignments, which also included keeping daily food and activity records.

Participants in the weight-loss medication therapy alone group also met with primary care physicians eight times for 10 to 15 minute visits, but were not instructed to keep food or activity records and were provided only general information on diet and exercise.

Those participants in the combined therapy group received both the lifestyle modification therapy and the weight-loss medication. All groups were prescribed a 1200 to 1500 calorie diet and the same exercise plan.

After one year, patients in the weight-loss medication plus lifestyle group lost an average of more than 26 pounds — more than double the weight loss seen with medication alone (11 pounds).

In addition, 73 percent of participants in the combined therapy group lost 5 percent or more of their initial body weight, compared to 56 percent of participants in the brief therapy plus weight-loss medication group, 53 percent of participants in the lifestyle modification alone group, and 42 percent of participants in the weight-loss medication alone therapy group.

More than half or 52 percent of people in the combined therapy group lost 10 percent or more of their initial body weight compared to 29 percent of participants in the lifestyle modification alone group, 26 percent of participants in the brief therapy plus weight-loss medication group, and 26 percent of participants in the weight-loss medication alone group.

Interestingly, those participants in the combined therapy group who were most successful were those who frequently recorded their food intake. Those participants with high adherence to food intake record keeping lost more than twice as much weight as those with low adherence (41.5 versus 17 pounds).

“Some people have questions about how they can do lifestyle modification,” says Dr. Wadden. “I think that a first step is to complete daily food logs. Food records help people become aware of their eating patterns and identifying areas for improvement.” Dr. Wadden adds that the second step to weight loss is to increase physical activity and one of the best ways to do that is to obtain a pedometer to count steps and gradually increase daily walking.

One limitation of the study is that it only included obese patients who were otherwise healthy and excluded obese patients with health problems possibly related to their obesity, such as hypertension, cardiovascular disease, cerebrovascular disease, kidney disease, liver disease, and diabetes.

Because many obese patients also have other conditions that can adversely affect their health, physicians should carefully monitor patients enrolled in weight-loss programs that include weight-loss medications.

The findings of the study are consistent with the NIH Obesity Clinical Guidelines, which recommend that weight loss medications be used in a supportive role to a comprehensive program of behavioral treatment, diet therapy, and increased physical activity.

The NIH Obesity Clinical Guidelines state that the most successful strategies for weight loss include calorie reduction, increased physical activity, and behavioral therapy designed to improve eating and physical activity habits. The Guidelines also recommend that physicians prescribe a regimen of lifestyle therapy for at least six months before adding weight-loss medication to the regimen. More information on the NIH Obesity Clinical Guidelines is available on the NIH web site at http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm.

According to data from the 1999 to 2000 National Health and Examination Survey (NHANES), approximately 65 percent of Americans aged 20 years or older are overweight with 31 percent of adults obese as defined by body mass index (BMI). BMI is a calculation that takes into account both height and weight. Overweight is defined as having a BMI of 25 to 29.9 kg/m2. Obesity is defined as having a BMI of 30 kg/m2 or higher. The NIDDK Weight-control Information Network fact sheet, Statistics Related to Overweight and Obesity (http://win.niddk.nih.gov/statistics/index.htm) provides more information.

NIDDK, part of the National Institutes of Health (NIH), conducts and supports research on diabetes; endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Daily Weighing Helps People Lose Weight, Prevents Gain

By Milly Dawson, Health Behavior News Service

People who are trying to either lose weight or avoid gaining do better by weighing themselves daily, according to a new study in the December issue of Annals of Behavioral Medicine.

The research team evaluated self-weighing practices of more than 3,000 people participating in either a weight-loss or a weight-gain prevention program. The study's key finding: “Higher weighing frequency was associated with greater 24-month weight loss or less weight gain.”

When people weigh themselves daily, “something is going on. It’s independent of things such as diet and exercise, so it may be worth recommending,” said lead researcher Jennifer Linde, an associate professor at the University of Minnesota.

“If people see that their number has gone up they may realize it's time to do something. It's probably easier to make that small correction,” Linde said, than to try to compensate after gaining a lot of weight.

The first study group consisted of 1,800 obese or overweight adults enrolled in a weight-loss program. Participants all had a body mass index (BMI) of at least 27. They were randomly divided into three groups: a telephone-based weight-loss intervention, a mail-based weight loss intervention or a usual-care control condition. The researchers weighed them every six months for two years.

“The average 12-month and 24-month weight losses of 1.3 and 2 BMI units respectively … were in the clinically significant range,” reported the researchers.

The other group consisted of 1,226 overweight adults — BMI above 25 — enrolled in a weight–gain prevention program. They were randomly divided into either an educational weight-control intervention, the same educational intervention plus a reward for returning self-monitoring postcards or a minimal-contact control condition. The researchers weighed the participants at the study's outset and every year for three years.

For the weight-gain prevention group, the researchers found that “the control group decreased weighing over time and both intervention groups increased weighing over time.” Even though weight maintenance was the goal for this group, daily weighing also led to weight loss at the 12- and 24-months time points.

Well-known behavioral programs such as Weight-Watchers(TM) have not widely recommended that followers weigh themselves daily; instead, many programs recommend weekly self-weighing. Public health recommendations from the Centers for Disease Control do not include self-weighing at all.

The researchers say their results suggest that “clinical as well as public health recommendations for regular weighing should be considered.”

“It is not surprising that daily weighing correlates with success — people who do well like the feedback,” says Kelly D. Brownell, director of the Yale Center for Eating and Weight Disorders. “I suspect it helps people who are succeeding and is a problem for people who are not losing or losing slowly, but the only way to tell is with a randomized trial that assigns people to different weighing schedules.”

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