Prescription Weight Loss Medications
August 31st, 2008 | by Kevin Flatt |
Prescription weight loss medications - Only 26.7% of prescription weight loss medication users reported following recommended diet and physical activity behaviors in this study.
Lifestyle modifications, including behavior therapy, diet, and physical activity, are the cornerstone of weight management.
Current weight management guidelines state that prescription weight loss medications may be used as part of a comprehensive weight loss program including diet and physical activity modifications.
These modifications include increasing physical activity to 30 to 45 minutes on most days of the week and reducing daily caloric intake by 500 to 1000 calories.
Clinical research also suggests that increasing consumption of whole grains, fruits, and vegetables in place of calorie-dense foods may increase satiety and decrease overall caloric intake aiding weight management.
The initial goal of weight loss therapy is to reduce body weight by approximately 10% over a 6-month period.
Even small losses in weight, such as 5% to 10%, have been found to reduce blood pressure, cholesterol and triglycerides levels, and reduce blood glucose levels among overweight and obese persons without diabetes.
Weight loss attributable to prescription weight loss drugs is modest, about 3% to 8% of body weight, and is based on a small number of patients assigned to drug treatment in clinical trials.
Lifestyle modification in combination with pharmacotherapy has been shown to improve weight loss more effectively than pharmacotherapy alone. However, in the general population, data suggests that only one-fifth of individuals who were trying to lose weight reported using the recommended combination of eating fewer calories and meeting weekly physical activity recommendations.
Using population-based data we estimated that 4.6 million American adults used prescription weight loss medications between 1996 and 1998.
During this period, obesity medications included phentermine, fenfluramine, dexfenfluramine, and sibutramine.
Because of the paucity of population-based data on behaviors among persons using prescription weight loss medications, the purpose of our study was to further examine demographic and behavioral characteristics related to the reported use of prescription weight loss medications collected in the late 1990s as part of a national dataset.
These data were collected the same year as issuance of guidelines for assessment and treatment of obesity and therefore provide baseline estimates.
Specifically, we examined 1) prescription weight loss medication use by demographic and behavioral characteristics, 2) 10% weight loss among prescription weight loss medication users by demographic and behavioral characteristics, and 3) diet and physical activity behaviors among those who used prescription weight loss medications at the time of the survey.
Although in 1998 clinical guidelines recommended that prescription medication for obesity be used in conjunction with lifestyle modifications, we found that during that same year only one quarter of current prescription weight loss medication users reported minimal diet (eating fewer calories) and physical activity behaviors recommended for weight loss.
Our analyses indicated that meeting these recommendations was low across all sociodemographic groups (<40%) and, men were less likely to meet recommendations compared to women.
Although patterns of prescription medication use differed by sex, for both men and women the odds of use was higher among those who were obese compared to those who were overweight although at different magnitudes.
Our data show than more overweight women used prescription weight loss medications (4.88%) than did obese men (3.11%). It is possible that pharmacotherapy prescribing patterns differ by sex since more women than men attempt weight loss or that for men, a higher BMI is needed before personal action regarding weight is taken.
Eating fruits and vegetables and taking part in recommended levels of physical activity through leisure-time activities were more frequent behaviors among prescription weight loss medications users who had lost at least 10% of their body weight.
Although we had no direct measurements of caloric intake, fruits and vegetables in their natural state are low in energy density. Thus, adding or substituting fruits and vegetables for energy-dense snacks and sweets can impact satiety and weight gain.
Our analyses also indicate that those respondents who met the minimal recommendations for leisure-time physical activity had twice the odds of having lost 10% of their body weight compared to those who were sedentary.
We observed higher odds of 10% weight loss for those with at least 150 weekly minutes, but the magnitude did not appear to have a dose effect. We believe additional research is needed to determine whether physical activity modifications require greater duration, such as exercising 60 minutes or more daily to prevent weight regain as has been suggested by the Institute of Medicine, to improve the efficacy of currently approved obesity pharmacotherapy for weight management.
About 40% of current prescription weight loss medications users who both reduced calories and met leisure-time physical activity recommendations had lost 10% of their body weight.
Our data also show that respondents who consumed usually less than 5 fruits and vegetables per day were less likely to meet both diet and physical activity recommendations than did those who consumed 5 or more fruits and vegetables a day.
Because fewer than half of physicians counsel obese patients about weight control we believe the opportunity exists for physicians and other health care professionals to provide counseling that emphasizes appropriate weight control practices that include regular physical activity and a balanced low-calorie diet which includes increasing consumption of fruits and vegetables.
Although we found that about one fifth of participants had lost between 5% and 9% of their pretreatment body weight and one third of participants had lost at least 10% of their pretreatment body weight, the pill dosage and length of medication use were not collected.
Therefore, some users may have used pills for a short time, such as less than 6 months, and would not be expected to have lost 5% to 10% of their body weight.
In current practice, physicians treating obesity can prescribe phentermine, sibutramine, and orlistat (available April 1999).
Analysis of national data on patient visits found that phentermine was the most common antiobesity medication in 2001 and in early 2002 (based on January through March figures), suggesting that our data, although collected in 1998, has relevance to current weight management.
Most nonsurgical obesity treatments lead to weight loss for the first 6 months followed by regain.
Therefore, some health care professionals suggest that prescription weight loss medication be prescribed either to enhance weight loss during the active weight-loss phase or to prevent later regain.
In our study, 9% of current medication users reported that they were currently trying to maintain their weight.
We observed that the behaviors of these individuals differed from those who said they were currently trying to lose weight, e.g. fewer reported eating less calories, fewer met physical-activity recommendations, and fewer were advised by a health care professional to either lose or maintain weight.
Additional research is needed on use of pharmacotherapy for weight maintenance.
We found that one in ten obese women and one in 33 obese men reported using a prescription weight loss medication in the past two years.
Among medication users, one-third of women and one quarter of men reported a 10% weight loss.
Only one quarter of current medication users reported the minimal diet and physical activity behaviors recommended for weight loss.
Ongoing population-based surveillance is needed to assess the prevalence of prescription weight loss medication use and whether pharmacotherapy users are making appropriate lifestyle changes in order to lose or maintain weight.
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Reference:
Extracted and adapted from: Blanck HM, Khan LK, Serdula MK. Diet and physical activity behavior among users of prescription weight loss medications. International Journal of Behavioral Nutrition and Physical Activity 2004, 1:17 (23 December 2004). © 2004 Blanck et al; licensee BioMed Central Ltd. © 2004 Blanck et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).
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