Abstract
Obesity is a major health problem in western society. Although the most common cause of obesity is overeating, the etiology is often multifactorial. Recently, there has been an increased interest in the role of pharmacologic therapy in the multi-modal approach to treating obesity. However, many physicians are prescribing drug therapy alone. We wished to investigate whether or not behavior modification is additive to the drug therapy of obesity. Methods: We conducted a 6 month single blinded study in which 44 healthy subjects with a body mass index (BMI) of 27-50 kg/m2 were randomized; half to a group referred for nutrition counseling, exercise advice and behavior modification in addition to treatment with phentermine 30 mg/day plus fenfluramine 20 mg TID; and half to a group receiving the two drugs alone. A self-report questionnaire was also included. Results: Weight loss in the referred group: 11.5±2.3 kg vs. non-referred: 7.4±4.9 kg (p=0.05). Change in BMI: referred group: -4.1̈2.3 vs. non-referred: -2.9±1.9 (p=0.099). There was a positive correlation between quality of life and the amount of weight loss achieved (r = 0.46, p =0.002). These results demonstrate that although there is some degree of weight loss obtained using phentermine plus fenfluramine alone, a multi-modal approach utilizing exercise, nutrition counseling and behavior modification is more effective in achieving successful long term weight loss in mild to moderately obese subjects.