LIFE-STYLE MODIFICATION IN THE PHARMACOLOGICAL TREATMENT OF OBESITY -A PILOT INVESTIGATION OF A POTENTIAL PRIMARY-CARE APPROACH

This study examined a new method of providing brief, individual lifest yle modification to obese individuals treated by pharmacotherapy. Twen ty-six women with a mean (+/-SD) age of 47.0 +/- 7.2 years, weight of 97.6 +/- 13.0 kg, and body mass index of 36.5 +/- 5.0 kg/m(2) were pre scribed 60 mg/d of fenfluramine and 15 mg/d of phentermine for one yea r. In addition, half of the women were randomly assigned to traditiona l group behavior modification, conducted by a nutritionist, which incl uded 32 75-minute sessions during the year. The other half were provid ed lifestyle modification by a physician during 10 15-20 minute struct ured visits. All participants received identical treatment manuals and comparable assignments for behavior change. At the end of one year, p atients in the physician group achieved the same highly successful wei ght losses as those treated by group behavior modification (13.9 +/- 9 .6 kg vs. 15.4 +/- 7.9 kg, respectively). Treatment was associated wit h highly significant improvements in lipids and lipoproteins, as well as in mood and several measures of appetite. Weight loss the first fou r weeks, as web as patient completion of daily food records during the first Is weeks, correlated positively with weight loss at weeks 18, 2 6, and 52. Results of this study await replication using larger sample s but strongly suggest that effective lifestyle modification can be pr ovided during brief, structured physician visits. The findings are dis cussed in terms of their implications for the treatment of obesity in primary care practice.