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 associated diseases, such as type 2 diabetes, heart disease and some forms of cancer, says Dr. Elias A. Zerhouni, former NIH director.

Lifestyle modification should be the first line of treatment for obesity, says Dr. Susan Yanovski, director of the Obesity and Eating Disorders Program for the National Institute of Diabetes and Digestive and Kidney Diseases (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, notes Dr. Yanovski.

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 Dr. Thomas A. Wadden, lead author of the study. Dr. Wadden is a professor of psychology at the University of Pennsylvania School of Medicine.

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, explains Dr. Wadden.

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

The researchers included the fourth treatment group to measure the effectiveness of weight-loss medication combined with brief lifestyle modification counselling 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.

Lifestyle Changes Linked To Success

Participants in the lifestyle modification therapy group attended a total of 30 group meetings that each lasted 90 minutes.

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 counselling group met with primary care physicians eight times for 10 to 15 minute visits. There, they were given homework assignments, which also included keeping daily food and activity records.

Participants in the weight-loss medication alone therapy 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."

Physical Activity Is Key
Dr. Wadden adds that the second step to weight loss is to increase physical activity. 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 behavioural 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 diet.

Tips for success with the Therapeutic Lifestyle Changes (TLC) diet

• Work with your doctor on a plan to lower your cholesterol through diet.
• Gather detailed, easy-to-understand educational materials about the diet.
• Gather information about menus, cooking classes, support groups, books and videos.
• Get support from your family in making changes in your diet.
• Think ahead and make realistic and customized meal plans.
• Get the help of a registered dietician if you have questions about the TLC diet.
• Change the way you plan, prepare and eat every meal.
• Learn how to read and understand food labels. Look for the amount of saturated fat per serving and determine the percentage of your total saturated fat intake for the day. "Low-fat" does not always mean what it seems. Some labels measure fat content by weight rather than as a percentage of the calories in a serving.
• Limit fast food. It can be difficult to choose a low-fat alternative.
• Exercise. Always consult your doctor before beginning an exercise program.