A third study, published in 2006, examined the effects of three strategies designed to help with weight maintenance. The study subjects were 314 people who had lost 10% of their body weight in the previous two years. One group (the “control” group) received a quarterly newsletter with information about diet, exercise, and weight control. Members of the other two groups were each given a scale with instructions on how to use it. Both groups reported their weight on a weekly basis by phone or via the Internet and received rewards, encouragement, and additional weight-loss tools depending on whether they maintained their weight or gained weight. One of these groups (the “face-to-face” group) attended first weekly then monthly meetings at a clinic for 18 months. The other group (the “Internet” group) used laptop computers to participate in similar meetings in chat rooms (in which messages are typed and appear on the computer screen).
Compared to the control group, the two other groups regained less weight, with the participants of the face-to-face group regaining the least. The researchers concluded that daily weighing improved maintenance of weight loss and that the type of education and support that their study provided worked best in a face-to-face format.
In some cases, certain drugs can help with weight loss and maintenance, although it should be noted that all weight-loss drugs are intended to be used along with a program of diet and exercise, not in place of diet and exercise.
In the United States, there are two prescription medicines approved for long-term use in the treatment of obesity: orlistat (brand name Xenical), and sibutramine (Meridia). In June 2007, a lower-dose version of orlistat, marketed under the brand name Alli, became available over the counter for use in adults age 18 and over.
Orlistat helps with weight loss by blocking the absorption of some of the fat a person eats. While few studies have looked at the use of orlistat beyond two years, a large, four-year study published in the journal Diabetes Care in 2004 looked at the effectiveness of using orlistat along with lifestyle changes in the prevention of Type 2 diabetes. The 3,304 study subjects were obese at the start of the study, and some had impaired glucose tolerance (which is now called prediabetes), while others did not. All were prescribed a reduced-calorie diet, given dietary counseling, and encouraged to walk at least one extra kilometer (0.62 mile) a day beyond their usual physical activity. Some additionally took orlistat, while others took a placebo (a pill with no active ingredient).
After four years, the subjects taking orlistat had lost more weight than those taking the placebo. In addition, fewer participants with prediabetes who were taking orlistat developed Type 2 diabetes. Participants taking orlistat also had significant improvements in blood pressure, waist circumference, and blood lipid levels.
Sibutramine works by directly targeting the brain. It reduces appetite by increasing the amount of time two neurotransmitters (noradrenaline and serotonin) have to act by preventing them from being reabsorbed by the brain cells (neurons) that produce them. It is believed that this effect increases feelings of fullness. Use of sibutramine has been shown to result in a 5% to 10% reduction in a person’s body weight.
Modest increases in heart rate and blood pressure can result from sibutramine use early in the course of treatment, so it’s currently recommended that blood pressure be closely monitored in people taking sibutramine and that people with serious cardiovascular problems not take it. Other side effects may include dry mouth, insomnia, loss of appetite, constipation, and headache.