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| |  ACP: New and Proven Therapies for Treating Obesity By K.L. Capozza SAN FRANCISCO, CA -- April 15, 2005 -- To effectively address the increased incidence of obesity and obesity-related conditions, doctors need to learn to talk to their patients about weight loss, said Caroline M. Apovian, MD, director, Nutrition and Weight Management Center, Boston University Medical Center, Boston, Massachusetts, United States. During her presentation here on April 14th at the American College of Physicians annual session, Dr. Apovian discussed the latest research on weight loss and treatments. Broaching the subject with patients can be uncomfortable. However, studies show that doctor-physician discussions about weight loss are a highly effective tool for changing patient behavior. "The bottom line is the doctor is a very important player in the weight loss game," Apovian said. With so many mixed messages in the media and commercial advertisements, patients need the help of their physicians to sort through the dieting and weight loss morass, Dr. Apovian said. For example, much has been made of the tummy trimming properties of the Atkins, or low-carbohydrate diet. Diets like Atkins appear to help patients lose weight by increasing fullness after meals and restricting food options. But the restrictive regimen can be difficult to maintain over time, she said. Indeed, a low carbohydrate diet appears to help patients lose more weight than other diets up until the 6-month mark. But by 1 year, the difference between low-carbohydrate and low fat diets disappears, she said. Doctors should help patients choose a diet that helps them reduce portion size and that includes a healthy eating lifestyle they can stick to, Dr. Apovian said. "What an individual will adhere to, not the macronutrient combination, is the key," she said. Preliminary research on new internet-based weight loss programs suggests the technology may be a useful tool for some patients. A 2001 randomized controlled trial published in the Journal of the American Medical Association found that overweight patients who had access to online weight loss resources lost on average 1.6 kg over 6 months. Subjects who also submitted calorie and exercise information to an online bulletin board and received weekly e-mail counseling and feedback lost considerably more, or 4.1 kg over the same time period, she said. As new drug therapies for weight reduction are coming down the pike, clinicians should be aware of both the efficacy and side effects of these new pharmaceuticals. Daniel H. Bessesen, MD, associate professor of medicine at the University of Colorado Health Sciences Center, Denver, Colorado, United States, said physicians who are resistant to pharmacotherapy for obesity management should weigh the overall health benefits of weight loss against the drawbacks, such as cost, adverse effects and poor adherence. Current medications offer between 5% and 8% weight loss when subtracted for a placebo effect. And when taken in combination with behavior modification therapy, the drugs appear to facilitate even more weight loss. However, treatment probably needs to be life long, many insurers will not cover the cost, and the drugs may not be safe for long-term therapy. Some evidence suggests weight loss drugs may not have to be taken consistently over the long term. Preliminary research shows that intermittent therapy with the drug sibutramine may deliver the same results over the long term as it does when taken in uninterrupted therapy. "Currently available medications are a reasonable adjunctive therapy for some obese patients. Newer medications are likely to come along in coming years," Dr. Bessesen noted.
Studies Mentioned:
[Presentation title: Obesity Medicine: Emergence of a New Discipline]
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