Treatment of obesity: comparison of physician and nonphysician therapists using placebo and anorectic drugs in a double-blind trial. One-year outcome of a combination of weight loss therapies for subjects with type 2 diabetes: a randomized trial. Well-being and morbid obesity in women: a controlled therapy evaluation. Small Changes in Nutrition and Physical Activity Promote Weight Loss and Maintenance: 3-Month Evidence from the ASPIRE Randomized Trial Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. High-dose naltrexone therapy and dietary counseling for obesity Evaluating success of weight loss programs, with an application to fluoxetine weight reduction clinical trial data. Rational design of a combination medication for the treatment of obesity. A 12-Week Weight Reduction Intervention for Overweight Individuals Taking Antipsychotic Medications Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat. Elearning approaches to prevent weight gain in young adults: A randomized controlled study. A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up. A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics A randomized, triple masked, placebo-controlled clinical trial for controlling childhood obesity A multicenter evaluation of a proprietary weight reduction program for the treatment of marked obesity.
In a r and omized double-blind trial , 60 obese patients were assigned in groups of 12 to five therapists . The patients for each therapist were then r and omly assigned in groups of four to placebo or one of two preparations of mazindol . Ninety-three percent of the patients completed the nine weeks of treatment . Weight loss averaged 1.1 lb per week and there was no advantage to pharmacological agents over placebo . However , there were significant differences between therapists . Weight loss by the patients assigned to physicians was no better than for those assigned to nonphysician personnel , but there were significant differences between individual nonphysician personnel . These findings support the concept that nonphysician personnel may be effective in treating many obese patients . In addition , we could not find a significant effect of either form of mazindol when compared to placebo OBJECTIVE The purpose of this study was to evaluate the effects of a combination weight loss program using intermittent low-calorie diets , energy-controlled meal replacement products , and sibutramine on weight loss , diabetes control , and cardiovascular risk factors in overweight or obese subjects with type 2 diabetes . RESEARCH DESIGN AND METHODS Overweight or obese individuals with type 2 diabetes treated with diet or oral medication were r and omly assigned to either a st and ard therapy or combination therapy group . Both groups received a st and ardized program to facilitate weight loss . The combination therapy group also received 10 - 15 mg sibutramine daily , low-calorie diets using meal replacement products for 1 week every 2 months , and between low-calorie diet weeks , once daily use of meal replacement product and snack bars to replace one usual meal and snack . Primary outcome measures were changes in body weight , glycemic control , plasma lipids , blood pressure , pulse , and body composition at 1 year . RESULTS At 1 year , combination therapy , compared with st and ard therapy , result ed in significantly more weight loss ( -7.3 + /- 1.3 kg vs. -0.8 + /- 0.9 kg , P < 0.001 ) and reduction in HbA(1c ) ( -0.6 + /- 0.3 vs. 0.0 + /- 0.2 % , P = 0.05 ) . Combination therapy result ed in reduced requirement for diabetes medications and decreased fat mass and lean body mass . A 5-kg decrease in weight at 1 year was associated with a decrease of 0.4 % in HbA(1c ) ( P = 0.006 ) . Changes in fasting glucose , lipids , pulse , and blood pressure did not differ between groups . CONCLUSIONS This combination weight loss  program result ed in greater weight loss and improved diabetes control compared with a st and ard weight loss program in overweight or obese subjects with type 2 diabetes OBJECTIVE Morbidly obese individuals are unlikely to reach and maintain normative weights . Thus , interventions aim ed at alleviating corollary problems , independent of attempts at weight loss , are appropriate . A cognitive group treatment program ( CT ) was developed which incorporated a nondieting approach , regular exercise , and use of alternative coping skills . Weight loss per se was not a focus of the intervention . The purpose of the current work was to evaluate this program in a controlled , comparative treatment outcome study . METHOD Sixty-two obese women with a history of treatment failures were r and omly assigned to the CT program , a behavior therapy weight loss program ( BT ) , or a wait-list control group . RESULTS For CT participants , depression , anxiety , and eating-related psychopathology decreased significantly over the course of treatment while perceptions of self-control increased ; BT and control subjects showed no significant changes in these variables . Women in both active treatment groups lost significant amounts of weight , while members of the control group showed a nonsignificant increase in weight . At 6-month follow-up , treatment benefits were maintained . DISCUSSION Findings suggest that interventions not directly aim ed at weight loss can enhance psychological well-being and thus may be appropriate for some obese women Background Current obesity interventions use intensive behavior changes to achieve large initial weight loss . However , weight regain after treatment is common , and drop out rates are relatively high . Smaller behavioral changes could produce initial weight loss and be easier to sustain after active treatment . Purpose We examined the efficacy of an intervention that targeted small but cumulative participant-chosen changes in diet and physical activity (  ASPIRE ) and compared this treatment to st and ard didactic and wait-list control groups . The primary outcome measures were body weight , waist circumference , and intra-abdominal fat . Methods Fifty-nine overweight or obese sedentary adults were r and omized to one of three groups : ( 1 ) the ASPIRE group ( n = 20 ) , ( 2 ) a st and ard educationally-based treatment group ( n = 20 ) , or ( 3 ) a wait list control group ( n = 19 ) for 4 months . Active treatment groups received identical resistance and aerobic training programs . Results Intention-to-treat analyses showed that participants in the ASPIRE group lost significantly more weight than the st and ard and control groups ( −4.4 vs. −1.1 and + 0.1 kg , respectively ) , and the greater initial weight loss in the ASPIRE group was sustained 3 months after active treatment ( 4.1 kg ) . An alternative analytic strategy ( 0.3 kg/month weight gain for those lost to follow-up ) showed continued weight loss ( −0.2 kg after active treatment ; −4.6 kg from baseline ) at follow-up in the ASPIRE group . Similar patterns were observed for the other adiposity measures . Conclusion More modest behavioral changes are capable of promoting weight loss , decreasing adiposity markers and sustaining these changes over 3 months . Longer-term studies comparing this approach with traditional behavioral weight loss treatments are warranted OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity There is considerable evidence that antagonism of the endogenous opioids will suppress food intake in a variety of animal species . The authors report a double-blind , placebo-controlled trial of the long-acting , orally active narcotic antagonist naltrexone in the promotion of weight loss in obese male subjects who were also undergoing dietary counseling for weight reduction . Subjects received medication ( naltrexone , 300 mg/day or placebo ) for 8 weeks following an initial 2-week single-blind placebo phase . The results failed to demonstrate an advantage for the active drug . However , the naltrexone was associated with hepatotoxicity when used at this dosage in this population We modified criteria for judging successful obesity treatment  proposed by Atkinson to provide objective criteria for successful benefit from weight reduction programs with respect to data from a clinical trial . The criteria include assessment s of changes in both weight-related factors ( e.g. excess weight , excess body fat ) and obesity-related risk factors ( e.g. hypertension , hyperglycemia , hyperlipemia ) . To demonstrate the use of this methodology , we applied the criteria in an analysis of eight r and omized , double-blind controlled trials comparing fluoxetine ( n = 522 ) with placebo ( n = 504 ) for weight loss .  The results suggest these criteria can be useful for evaluating a treatment program or for comparing treatments from clinical trials Existing obesity therapies are limited by safety concerns and modest efficacy reflecting a weight loss plateau . Here , we explore combination therapy with bupropion ( BUP ) , a putative stimulator of melanocortin pathways , and an opioid antagonist , naltrexone ( NAL ) , to antagonize an inhibitory feedback loop that limits sustained weight reduction . In vitro electrophysiologic experiments were conducted to determine the extent to which BUP+NAL stimulated hypothalamic pro-opiomelanocortin ( POMC ) neurons in mouse brain . A subsequent study further characterized the effect of combination BUP+NAL treatment on food intake in lean and obese mice . Finally , a r and omized , blinded , placebo-controlled trial in obese adult subjects was conducted . R and omization included : BUP ( 300 mg ) + NAL ( 50 mg ) , BUP ( 300 mg ) + placebo ( P ) , NAL ( 50 mg ) + P or P+P for up to 24 weeks . BUP+NAL stimulated murine POMC neurons in vitro and caused a greater reduction in acute food intake than either monotherapy , an effect consistent with synergism . Combined BUP+NAL provided sustained weight loss without evidence of an efficacy plateau through 24 weeks of treatment . BUP+NAL completers diverged from NAL+P ( P < 0.01 ) and P+P ( P < 0.001 ) at week 16 and from BUP+P by week 24 ( P < 0.05 ) . The combination was also well tolerated . Translational studies indicated that BUP+NAL therapy produced synergistic weight loss which exceeded either BUP or NAL alone . These results supported the hypothesis that NAL , through blockade of beta-endorphin mediated POMC autoinhibition , prevents the classic weight loss plateau observed with monotherapies such as BUP . This novel treatment approach ( BUP+NAL ) holds promise for the treatment of People taking antipsychotic medications  are at increased risk for obesity , diabetes , and early mortality . Few weight loss interventions have targeted this population . Thirty-six individuals were r and omized to an evidence -based 12-week weight loss intervention ( PREMIER with DASH diet , n = 18 ) or to usual care ( n = 18 ) in this feasibility trial . Average attendance was 8.6 of 12 sessions . Intent-to-treat analyses of covariance , adjusted for baseline weight , showed significant changes in weight : Mean weight in intervention participants declined from 213.3 to 206.6 pounds , while control participants ’ weight was unchanged . It is possible to recruit , assess , intervene with , and retain participants taking antipsychotic medications  in a dietary and exercise lifestyle change trial . Participants reported high levels of satisfaction with the intervention BACKGROUND Few evidence -based weight loss treatment options exist for medically vulnerable patients in the primary care setting . METHODS We conducted a 2-arm , 24-month r and omized effectiveness trial in 3 Boston community health centers ( from February 1 , 2008 , through May 2 , 2011 ) . Participants were 365 obese patients receiving hypertension treatment ( 71.2 % black , 13.1 % Hispanic , 68.5 % female , and 32.9 % with less than a high school educational level ) . We r and omized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components . The intervention included tailored behavior change goals , self-monitoring , and skills training , available via a website or interactive voice response ; 18 telephone counseling calls ; primary care provider endorsement ; 12 optional group support sessions ; and links with community re sources . RESULTS At 24 months , weight change in the intervention group compared with that in the usual care group was -1.03 kg ( 95 % CI , -2.03 to -0.03 kg ) . Twenty-four-month change in body mass index ( calculated as weight in kilograms divided by height in meters squared ) in the intervention group compared with that in the usual care group was -0.38 ( 95 % CI , -0.75 to -0.004 ) . Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group ( area under the receiver operating characteristic curve , -1.07 kg ; 95 % CI , -1.94 to -0.22 ) . Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm . CONCLUSION The intervention produced modest weight losses , improved blood pressure control , and slowed systolic blood pressure increases in this high-risk , socioeconomically disadvantaged patient population . Trial Registration clinical trials.gov Identifier : NCT00661817 Context People who are obese have difficulty changing their lifestyle to lose weight . Contribution This trial compared 5 ways of providing support for lifestyle modification . It found that high-frequency telephone contact with a dietitian led to the same weight loss as in-person contact and more weight loss than with low-frequency or e-mail contact or no contact at all . Caution Many patients withdrew , and most were women . Implication Telephone contacts with dietitians are as effective as in-person appointments for helping patients lose weight , and both are more effective than education or occasional dietitian contact . The Editors Despite substantial increases in awareness of the disease burden associated with excess weight , the prevalence of obesity continues to increase ( 1 , 2 ) . Lifestyle modification , which includes a low-calorie diet , increased physical activity , and behavioral treatment , continues to be the cornerstone of weight management ( 3 ) . However , the inability of most patients to sustain long-term lifestyle changes makes pharmacotherapy an attractive option . In one trial , the addition of sibutramine , 15 mg/d , to a lifestyle modification program result ed in weight loss at 12 months that was nearly twice that of each treatment alone ( 4 ) . Academic medical centers typically produce the best weight-loss results by combining intensive behavioral modification programs with pharmacotherapy in a structured setting that requires patients to attend weekly individual or group behavioral treatment sessions led by dietitians or behavioral psychologists . Despite the additional benefits of combining interventions , primary care practitioners , the principal providers of obesity treatment ( 5 ) , frequently prescribe medications but offer minimal lifestyle counseling . Possible reasons for omitting lifestyle counseling may be little or no training in behavioral counseling ; inability to dedicate time for ongoing counseling ; lack of multidisciplinary staff ; inadequate infrastructure ; and costs associated with more frequent visits , which are seldom covered by medical insurance . As a result , investigators have begun to explore alternative methods of providing lifestyle modification , such as telephone contact or Internet- and e-maildelivered interventions , which could decrease the dem and s of onsite behavioral programs , improve patient adherence , and reduce costs ( 69 ) . However , to our knowledge , no study has directly compared these different methods of delivering and reinforcing the behavioral modification program . Thus , we aim ed to examine the effect of 5 methods of delivering a lifestyle modification program in combination with the weight-loss medication sibutramine . We hypothesized that high-frequency face-to-face meetings with a dietitian would produce the greatest weight loss , whereas self-help would be associated with the least . Weight loss with telephone and e-mail interventions were expected to fall between these 2 groups . Methods Study Design This was a 6-month , open-label study . We assigned participants to 1 of 5 intervention groups by using a computer-generated r and omization schedule consisting of r and omly permuted blocks . Block length was 5 . All groups received the same drug treatment , sibutramine , 10 mg/d , and a st and ardized lifestyle modification program for weight loss that included a printed manual and access to a weight-loss Web site . The method of delivering the lifestyle modification program varied among the intervention groups in frequency and type of contact with a dietitian . High frequency was weekly contact during the first 3 months and every other week during the following 3 months , and low frequency was monthly contact . The type of contact with the dietitian was either face-to-face or by telephone or e-mail . One group had no contact with a dietitianonly self-help with the lifestyle manual and access to the weight-loss Web site . We r and omly assigned patients to high-frequency face-to-face counseling ( HF-F2F ) , low-frequency face-to-face counseling ( LF-F2F ) , high-frequency telephone counseling ( HF-TEL ) , high-frequency e-mail counseling ( HF-EMAIL ) , and self-help ( SELF ) ( Figure 1 ) . Figure 1 . Study flow diagram . AE= adverse event ; HF-EMAIL= high-frequency e-mail counseling ; HF-F2F= high-frequency face-to-face counseling ; HF-TEL= high-frequency telephone counseling ; LF-F2F= low-frequency face-to-face counseling ; SELF= self-help . * High frequency was weekly contact during weeks 1 to 12 and every other week during weeks 13 to 24 . Low frequency was monthly contact . Participants defaulted at their request or were lost to follow-up . Study Sample Participants were to be men and women age 25 to 60 years who had a body mass index of at least 30 kg/m2 but less than 40 kg/m2 . Participants had their own physicians for routine medical care and received screening for trial eligibility after responding to advertisements placed in the community . They had to be eligible to receive sibutramine ( per the U.S. package insert ) , adhere to study -related procedures , and have access to the Internet and e-mail . We excluded participants if they had uncontrolled blood pressure ( 140/90 mm Hg ) ; type 1 or 2 diabetes ; coronary heart disease ; chronic congestive heart failure ; stroke ; substantial metabolic , hepatic , or renal disease ; current cancer ; or gastric bypass surgery . We also excluded persons who in the past 6 months had lost 10 % or more of their initial weight , participated in a structured weight-loss program , or taken weight-loss drugs .  We excluded women who were pregnant or breastfeeding , and women of childbearing potential had to use adequate contraception . The first participant visit took place in August 2004 , and the last participant was seen in April 2005 . The study was conducted at 12 U.S. research centers comprising mostly nonacademic , independent clinics that had experience running clinical trials with obese patients . Local ethics committees approved the trial . Outcomes and Measurements The study 's primary outcome was 6-month change in body weight . Secondary outcomes were 6-month changes in waist circumference ; lipid , glucose , and insulin levels ; blood pressure ; weight-related symptoms ; and quality of life . We obtained measurements of body weight , blood pressure , and pulse rate at baseline and at the end of weeks 2 , 4 , 12 , and 24 . We took waist circumference and biochemical measurements ( fasting lipid , glucose , and insulin levels ) at baseline and at the end of weeks 12 and 24 . We did safety laboratory measurements ( serum chemistry , hematology , and urinalysis ) at screening and at the end of the study . We assessed patient-reported quality of life and symptom distress at baseline and at 24 weeks by using vali date d measures : the Impact of Weight on Quality of Life-Lite ( IWQOL-Lite ) ( 10 ) and the Weight-Related Symptoms Measure ( WRSM ) ( 11 ) . We used percentage of contact participationcalculated as actual divided by expected contactas a measure of adherence to the intervention for the groups with dietitian contacts . We scheduled high-frequency groups for 18 contacts and low-frequency groups for 7 contacts . Lifestyle Modification Program We adapted the behavioral strategies and the support material s from the Diabetes Prevention Program ( www.bsc.gwu.edu/dpp/manuals.htmlvdoc ) . Study dietitians had st and ardized lifestyle and Web site training before participating in the trial and received ongoing support through monthly teleconferences led by a senior dietitian and regular teleconferences with the Web site developer . Caloric Intake We instructed all participants to adopt a 750 kcal/ddeficit diet with a minimum intake of 1000 kcal/d for women and 1200 kcal/d for men . We estimated daily caloric requirements at baseline by using the HarrisBenedict formula and adjusted downward if patients lost 9.1 kg during treatment . The macronutrient composition of the diet consisted of 15 % protein , 30 % ( or less ) fat , and 55 % carbohydrate . Physical Activity Recommendations We recommended walking as the primary method of physical activity . We gave all participants a pedometer and recommended increasing their number of steps per day by approximately 500 steps each week . We encouraged participants to build to a goal of 10000 steps per day . Behavioral Recommendations Behavioral treatment strategies included goal setting , self-monitoring ( including weekly weighing and completion of daily food intake and physical activity logs ) , stimulus control , enlisting the support of family and friends , use of problem-solving skills to overcome barriers , cognitive restructuring , and coping with slips and lapses . Support Material s All participants received the same support material s , which were a lifestyle modification manual ( both in print and electronic format ) and access to an interactive weight-loss Web site application . We encouraged participants to log on to the Web site at least once a week . Statistical Analysis We selected the sample size to provide the study with 80 % power to detect a 1.5 % difference in weight loss between any 2 of the 5 groups on the basis of a 2- sample t test at the 5 % level ( 2-sided ) assuming a common SD of 2.6 % . The primary statistical analysis used a mixed-model repeated- measures approach for longitudinal data . The mixed-model analysis included intervention , visit , and the intervention-by-visit interaction as fixed factors and baseline body weight as a covariate . We found clinical center to be an insignificant factor and removed it from the final model . This was a modified intention-to-treat analysis because it included all r and omly assigned participants who had a baseline measurement and at least 1 postbaseline measurement of body weight , and participants were considered members of the intervention group in which they were r and omly assigned , regardless of adherence . We did not follow participants who withdrew prematurely , but we used their partial data in the analysis . All 10 pairwise comparisons among the 5 intervention groups were to be OBJECTIVE There is a significant need for an obesity treatment model suitable for the primary care environment . We examined the effectiveness of a brief counselling intervention alone , in combination with orlistat , and drug-alone in a 12-month r and omized- clinical trial at a medical school obesity centre . METHODS Participants ( N = 250 ) with body mass index ( BMI ) > or=27 were r and omized .  Changes in body weight , lipids , blood pressure and serum glucose were examined . Drug adherence and attendance were also evaluated . RESULTS Completers analysis was conducted on 136 participants with data at baseline , 6 and 12 months and intention-to-treat analyses ( ITT ) for the total sample . Amongst completers , participants in the drug only ( P = 0.012 ) and drug + brief counselling ( P = 0.001 ) groups lost more weight ( mean + /- SD : -3.8 + /- 5.8 kg and -4.8 + /- 4.4 kg , respectively ) than participants in the brief counselling only group at 6 months ( -1.7 + /- 3.3 kg ) , but there were no significant group differences at 12 months . ITT model results were similar to completers at 6 months and remained significant at 12 months , but the weight losses were more modest ( <3 kg ) for both groups receiving orlistat . For brief counselling alone , participants gained weight ( 1.7 + /- 4.2 kg ) . Cardiovascular disease ( CVD ) parameter changes were negligible . CONCLUSIONS Pharmacotherapy alone or combined with brief counselling result ed in modest weight losses that had minimal impact on cardiovascular parameters , but were greater than brief counselling alone . Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care setting s , our study suggests that such minimal interventions provide minimal benefits OBJECTIVE Preventing obesity among young adults should be a preferred public health approach given the limited efficacy of treatment interventions . This study examined whether weight gain can be prevented by online approaches using two different behavioral models , one overtly directed at obesity and the other covertly . METHODS A three-group parallel r and omized controlled intervention was conducted in 2012 - 2013 ; 20,975 young adults were allocated a priori to one control and two " treatment " groups . Two treatment groups were offered online courses over 19 weeks on ( 1 ) personal weight control ( " Not the Ice Cream Van , " NTICV ) and , ( 2 ) political , environmental , and social issues around food ( " Goddess Demetra , " " GD " ) . Control group received no contact . The primary outcome was weight change over 40 weeks . RESULTS Within-group 40-week weight changes were different between groups ( P < 0.001 ) : Control ( n = 2,134 ) : + 2.0 kg ( 95 % CI = 1.5 , 2.3 kg ) ; NTICV ( n = 1,810 ) : -1.0 kg ( 95 % CI = -1.3 , -0.5 ) ; and GD ( n = 2,057 ) : -1.35 kg ( 95 % CI = -1.4 to -0.7 ) . Relative risks for weight gain vs. CONTROL NTICV = 0.13 kg ( 95 % CI = 0.10 , 0.15 ) , P < 0.0001 ; GD = 0.07 kg ( 95 % CI = 0.05 , 0.10 ) , P < 0.0001 . CONCLUSIONS Both interventions were associated with prevention of the weight gain observed among control subjects . This low-cost intervention could be widely transferable as one tool against the obesity epidemic . Outside the r and omized controlled trial setting , it could be enhanced using supporting advertising and social media OBJECTIVE The traditional goal of obesity therapy has been the reduction of body weight to an ideal st and ard . Patient difficulties , however , in reaching this goal have led to a re assessment of weight loss criteria . The Institute of Medicine of the National Academy of Sciences recently proposed that successful long-term weight loss be defined as the reduction of initial weight by 5 % or more and the maintenance of this loss for at least 1 year . The present study used these criteria to evaluate the long-term efficacy of a proprietary weight loss program . METHODS Patients were 621 persons who had completed a 26-week weight loss program that included 12 weeks of treatment by a very-low-calorie diet . They were recruited from a total of 1,283 eligible persons who had been treated at 36 clinics nationwide . Clinics were r and omly selected to participate . Patients ' weights were determined in telephone interviews initially conducted 2 years after treatment and then at yearly intervals through 5 years of follow-up . RESULTS At the end of treatment , men achieved a mean reduction in initial weight of 25.5 + /- 1 % and women 22.6 + /- 1 % . Subjects regained substantial amounts of weight by the 2-year follow-up but 77.5 % of men and 59.9 % of women still maintained losses of 5 % or more of body weight . At the 3-year follow-up , 53 % of the original sample ( of 621 persons ) maintained losses of 5 % or more and 35 % losses of 10 % or more . These trends were apparent 4 and 5 years after treatment but the dwindling sample sizes prevented definitive assessment s. DISCUSSION The findings showed that a program of lifestyle modification combined with the brief use of a very-low-calorie diet was associated with successful weight control in a substantial portion of patients several years after treatment . Long-term weight losses of 5 % or more of initial weight are likely to be associated with improvements in health complications Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Background The efficacy of pharmacological treatment in controlling  childhood obesity  is controversial . We aim ed to compare the effects of three types of drug regimens and placebo on generalized and abdominal obesity among obese children and adolescents who did not succeed to lose weight 3 months after lifestyle modification ( diet and exercise ) . Methods This triple-masked r and omized clinical trial was conducted among 180 participants aged 10–16 years . They were assigned r and omly to 4 groups of equal number to receive metformin , fluoxetine , a combination of the two drugs , or placebo . The trial lasted for 12 weeks and participants were followed up for an additional 12-week period . Results Overall , 91.1 % ( n=164 ) of the enrolled participants completed the trial . After the 12-week trial , the body mass index decreased significantly in all groups receiving medications [ approximately −1.2 ( 0.2 ) kg/m2 , P<0.05 ] . This decrease was not significant in the placebo group . Waist circumference decreased significantly in the groups receiving metformin [ −2.1 ( 0.4 ) cm , P=0.03 ) ] as well as in the group receiving a combination therapy of metformin and fluoxetine [ −2.5 ( 0.4 ) cm , P=0.01 ) ] . In the 24-week follow-up study , these anthropometric indexes were lower than the baseline in the group that had received a combination therapy of metformin and fluoxetine . No serious drug side-effects were reported . Conclusions A limited period of such treatment may help weight control , and might be used to encourage those children who have been refractory to weight loss for continuing the non-pharmacological programs . Our findings should be confirmed in future studies with a longer follow-up period BACKGROUND Congressional hearings initiated in March 1990 revealed that America 's $ 10 billion a year weight loss industry is subject to minimal regulation by federal agencies . Consumers are forced to rely on advertisements and testimonials when selecting treatment because no proprietary program has provided a prospect i ve assessment of its short- and long-term results of treatment . This report describes such an assessment . METHODS A total of 517 obese patients ( 407 women and 110 men ) participated in a proprietary program that included 12 weeks of treatment by very-low-calorie diet within a 26-week program of life-style modification . Patients were treated in two cohorts ( 6 months apart ) according to a st and ardized protocol implemented at 18 hospital-based clinics across the nation . RESULTS Fifty-six percent of women and 54 % of men completed treatment , at which time their weight losses ( mean + /- SEM ) were 22.0 + /- 0.6 and 32.1 + /- 1.4 kg , respectively . Weight losses of women and men who discontinued treatment averaged 14.3 + /- 0.7 and 20.0 + /- 1.6 kg , respectively . Weight loss was associated with significant improvements in blood pressure and total serum cholesterol levels . A 1-year follow-up evaluation of 74 % of patients in the second cohort who completed treatment revealed that they maintained 15.3 + /- 1.2 of their 24.8 + /- 1.0-kg end-of-treatment weight loss ; 59 % of patients maintained a loss of 10 kg or more . CONCLUSION We hope that this report will lead to the systematic evaluation of other proprietary weight loss programs and to the publication of findings that will permit consumers to make informed treatment decisions
There was no significant difference between the groups in the studies regarding L-carnitina and flaxseed .
There is a lack of evidence regarding quality studies justifying the use of alternative products for weight loss
OBJECTIVE The high dem and for obesity treatment and conventional therapies ' lack of effectiveness increases the use of alternative products .
This study was aim ed at assessing evidence from r and omised clinical trials regarding the effectiveness of alternative weight-loss products ' ingredients .