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U.S. NIH’s Obesity Guidelines Part 29: Drug therapy for weight loss, when it is appropriate
Friday, December 17, 2004 2:15 am Email this article
Lifestyle changes including behavior modification, a low-calorie-diet, and increased physical activity should be tried for at least six months before weight loss drugs are tried according to the U.S. NIH's Obesity Guidelines (p. xvi). If after six months of diet and exercise a patient fails to lose the recommended 1 pound per week, then drug therapy can be tried. (p. 85) Drug therapy causes an additional weight loss of 4-22 lbs
Weight loss drugs increase weight loss by 4-22 pounds, although some patients lose significantly more. (p. 84)
Loss during the first month predicts long-term success
Weight loss during the first month of drug treatment is a good predictor of long-term success. (p. 84)
People who lose less than 4 pounds during the first month are not likely to have much long-term success.
Comment: If it is going to work, you’ll know it right away
Comment: I believe this is true of all therapies; if it is going to work, you will know it within the first couple of weeks. One woman told me she was taking a handful of supplements daily that she bought from her doctor in order to lose weight, but after a month or two, she had not lost any weight loss, however, her doctor told her to keep taking the pills because they take a while to work. I think this is complete nonsense. If you don’t notice any weight loss within the the first month, it is probably not effective.
Long-term drug therapy is acceptable
If drug therapy enables a person to lose weight during the first six months and maintain weight after that, it may be continued provided there are no serious adverse effects. (p. 87) If not, drug therapy should be discontinued. (p. xxiii and 85)
Safety and efficacy of weight loss drugs should be continually assessed
The safety and efficacy of weight loss drugs should be continually assessed for every patient. Safety and efficacy of weight loss drugs has not been established beyond one year. (p. xvi)
Short-term drug therapy not effective
Weight loss drugs should be given singly in the lowest effective dose to reduce the likelihood of adverse effects. (p. 86) Short-term drug therapy of less than 3 months generally is not very effective. (p. 86)
Drug therapy usually causes weight loss in the first six months. (p. 54) The major role of diet drugs is to help a patient stay on a plan of diet and exercise. (p. 85)
Candidates for drug therapy
Drug therapy should only be used in carefully selected patients, and only as part of a comprehensive weight loss program which includes diet and exercise.
Drug therapy should be reserved for patients with a BMI of 30 or more, or a BMI of 27 or more if they also have with two or more obesity-related risk factors including hypertension, dyslipidemia, coronary heart disease, type 2 diabetes, and sleep apnea. (p. xvi, xxiii, 83 and 85)
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults : the evidence report / National Heart, Lung, and Blood Institute [Bethesda, Md.] : National Institutes of Health, National Heart, Lung, and Blood Institute, . NIH publication No. 98-4083.
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