LONG-TERM WEIGHT-LOSS - THE EFFECT OF PHARMACOLOGICAL AGENTS

We reviewed 20 English-language weight-reduction studies, reported bet ween 1967 and March 1993, of the effect of greater than or equal to 6 mo of pharmacologic therapy on weight loss and its maintenance to dete rmine the clinical benefits of extended treatment, propose treatment g uidelines, and identify future research needs. Pharmacologic agents in cluded phentermine, mazindol, fenfluramine, dexfenfluramine, and fluox etine. Study designs varied with respect to blinding, use of a single agent vs a combination, dosing, length of therapy, patient selection, adjunctive therapy, and visit frequency. At endpoint, weight loss vari ed from study to study but a plateauing of weight loss or weight regai n was observed after approximate to 6 mo. The benefits of extended tre atment appear to outweigh the risks for those patients who are unable to lose sufficient weight without pharmacologic therapy but who mainta in adequate weight loss with long-term pharmacologic therapy. Future s tudies should define and evaluate pharmacologically responsive and unr esponsive subgroups.