Drug therapy after very-low-calorie diets.
American Journal of Clinical Nutrition
Very-low-calorie diets (VLCDs) are effective at reducing weight, even in patients who have often failed with conventional diets. Maintaining weight lost by means of a VLCD remains a clinical challenge. Attempts to prevent weight regain by dietary reeducation or by more formal behavior-modification techniques are not easily applicable to large numbers of patients and are not always successful; the use of drugs to maintain and improve upon initial VLCD success could be of real clinical value. Pharmacological treatment of obesity has evolved in recent years with the development and licensing of potent serotonin agonists, such as dexfenfluramine (dF), acting as nonstimulant anorectic agents. Thermogenic drugs are not yet as advanced in clinical development and evaluation but offer the prospect of increasing energy output in the reduced obese patient. Drugs used to treat obesity need to be effective, to be safe, not to exhibit drug tolerance, and ideally, to be shown to reduce morbidity or mortality from obesity, particularly because treatment will need to be prolonged. Such requirements are not unique for treating obesity, they are similar for drugs used to treat other metabolic diseases such as hypercholesterolemia or diabetes. VLCD followed by dF has been shown to be effective. A double-blind trial randomized 45 patients who had successfully completed 8 wk of treatment on the Cambridge diet to either placebo or dF 15 mg twice daily for 26 wk. Patients continued on a diet giving 60-75% of daily energy needs. Patients treated with dF had lost 14.9 ± 0.9 kg on the Cambridge diet and lost a further 5.8 ± 1.8 kg. In contrast, patients who received placebo regained 2.9 ± 1.3 of the 13.5 ± 1.0 kg they had lost during VLCD. The total weight loss after 34 wk in total was thus 21.3 ± 2.6 versus 11.3 ± 1.9 kg. Patients were offered the option of continuing on dF, or switching from placebo, in an open continuation of the trial. Ten patients, regaining weight on placebo, stabilized their weight without further regain over the next 24 wk when switched to dF. Those continuing on dF showed a slight regain (3.0 ± 1.0 kg) over the next 12 wk, but had stabilized their weight over the next 12 wk with only a further 3 kg regain over the next 24 wk. A combined VLCD and drug approach offers an effective treatment over a prolonged period of time for even the most refractory and severely obese person. Longer follow-up and further trials to evaluate whether other drugs or treatment regimens are effective are needed.
|Title:||Drug therapy after very-low-calorie diets|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science|
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