Journal article
Use of Pharmacotherapy to Improve Weight Loss in Early Non-responders to Behavioral Treatment
Obesity (Silver Spring, Md.), Vol.31, pp.185-185
01 Nov 2023
Abstract
Background: Current guidelines recommend behavioral treatment (BT) as the first intervention for improving weight and cardiovascular disease risk in patients with obesity. However, a substantial minority (35%-50%) do not achieve a clinically meaningful loss of >5% with this intervention. Minimal early weight loss strongly predicts this outcome. Anti-obesity medications (AOMs) are recommended when target weight loss is not achieved; however, their efficacy among ВТ non-responders has not been tested. Methods: This double-blind, randomized trial evaluated whether augmenting ВТ with AOM improved 24-week weight loss, as compared to ВТ with placebo, in early non-responders to ВТ. Participants with obesity and without diabetes completed a 4-week ВТ run-in, and those who lost <2.0% of initial weight (early non-responders) were then randomized to an additional 24 weeks of: BT plus placebo (ВТ + P); or BT plus medication (ВТ + M; phentermine 15.0 mg/d). Early responders who lost >2.0% received ВТ alone and were not part of the randomized trial. Results: A total of 147 participants enrolled in the ВТ run-in and 76 were categorized as early non-responders. Of those, 71 (93.4%) provided a weight at week 24. ITT analyses including all randomized participants were conducted using linear mixed models. Early nonresponders had lost 0.6% of initial weight (SD = 1.1) at randomization and early responders lost 3.1% (SD = 1.0). Early non-responders assigned to ВТ + M had a greater mean (±SE) loss of 5.8 ± 0.7% of initial weight from randomization to week 24, as compared to 2.8 ± 0.7% for ВТ + P participants (p = 0.003). At week 24, 52.5% of ВТ + M participants had lost >5% since randomization, compared to 22.3% of ВТ + P participants (p = 0.008). Early responders lost 4.9 ± 0.6% from randomization to week 24. Conclusions: These findings support clinical guidelines recommending the addition of AOMs for patients who do not achieve weight loss targets with ВТ alone and indicate that individuals that do not lose weight weight with one treatment can succeed with a different type of intervention.
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Details
- Title
- Use of Pharmacotherapy to Improve Weight Loss in Early Non-responders to Behavioral Treatment
- Creators
- Jena TronieriEleanor GhanbariJonathan ChevinskyErica LafataAlyssa MinnickSimran RajpalSeamus WangKylie BurcawThomas Wadden
- Publication Details
- Obesity (Silver Spring, Md.), Vol.31, pp.185-185
- Publisher
- Blackwell Publishing Ltd
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychology; WELL Center
- Identifiers
- 991021880394604721