Long‐Term Drug Treatment of Obesity in a Private Practice Setting

Abstract

ATKINSON, RICHARD L, ROY C BLANK, DONALD LAS L RITCH. Long-term drug treatment of obesity in a private practice setting. Obes Res. 1997;5:57&586. This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over "desirable" bodyweight or body mass index >27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15.9 months, and average weight loss at the last visit was 11.6 kg, or 11.7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16.5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patients fell by 0.750 mmoVL (29 mg/dL) and 0.937 mmoVL (83 mg/dL), respectively. Adverse events were SCHUMACHER, NIKHIL V DHURANDHAR, DOUG- modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.

Comparison of the effects of sibutramine versus sibutramine plus metformin in obese women

“…However, overwhelming majority of studies has shown that mono drug therapy may not be enough to reach patient targets. Some investigators have suggested that greater weight loss might be achieved by combining the anti-obesity drugs [26,35] as they have different mechanisms of actions. Recently, Wadden et al [36] reported that the addition of orlistat to sibutramine did not induce further weight loss when compared to treatment by sibutramine alone.…”

Lower dosages of phentermine-fenfluramine given in the afternoon: Five cases with significant weight loss

“…reported a 15.9% weight loss in the first 34 weeks of treatment with phentermine-fenfluramine using three times the dosage of fenfluramine (60 mg per day) compared to the 20 mg per day used in our five cases. Other studies (Blackburn & Kanders, 1987;Atkinson, Blank, Schumacher, Levine, & Ritch, 1993;Bray, 1995;Goldstein & Potvin, 1994;Weintraub, 1992; have utilized from 20 to 120 mg of fenfluramine per day. Using a lower dose may decrease the frequency or severity of side effects and is more cost effective.…”

Comparison of the effect of orlistat vs orlistat plus metformin on weight loss and insulin resistance in obese women

“…In light of these considerations, the opinion of polypharmacy has risen. 19,20,23 In this connection, an additional effect of metformin plus orlistat therapy on weight loss and insulin resistance is expected. Surprisingly, on the contrary to our hypothesis, the combination of metformin and orlistat therapy did not significantly induce greater weight loss and decrement on insulin resistance as compared to orlistat alone.…”