Skip to main content
SpringerLink
Log in

Combination Therapies for Obesity

  • Chapter
The Management of Eating Disorders and Obesity

Part of the book series: Nutrition and Health ((NH))

  • 1709 Accesses

Abstract

With the realization that obesity is a disease, not a psychological problem, the horizons of obesity treatment have widened. The concept of drug treatment of obesity has gained more widespread acceptance, and the most recent and exciting developments in obesity treatment have involved the use of drugs as an integral component. Using the concept of obesity as a chronic disease, this chapter discusses the integration of the standard treatments of obesity, including diet, exercise (see Chapter13), and behavior modification (see Chapter14), with single medications or combinations of medications, as potentially more effective regimens for the long-term maintenance of weight loss than without use of medications (Table 1)

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Friedman JM. A war on obesity, not the obese. Science 2003; 299:856–858.

    Article  CAS  Google Scholar 

  2. Bray GA. Risks of obesity. Prim Care 2003; 30:281–299, v–vi.

    Google Scholar 

  3. Andersen T, Stokholm KH, Backer OG, Quaade F. Long-term (5-year) results after either horizontal gastroplasty or very-low calorie diet for morbid obesity. Int J Obesity 1988; 12:277–284.

    CAS  Google Scholar 

  4. Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five year perspective. Int J Obesity 1989; 13:39–46.

    Google Scholar 

  5. Wilson GT. Behavioral treatment of obesity: thirty years and counting. Adv Behav Res Ther 1993; 16: 31–75.

    Article  CAS  Google Scholar 

  6. Perri MG. Improving maintenance of weight loss following treatment by diet and lifestyle modification. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. New York, NY: Guilford, 1992, pp. 456–477

    Google Scholar 

  7. Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev 2000; 1:113–119.

    Article  CAS  Google Scholar 

  8. Coleman DL. Obese and diabetes: two mutant genes causing diabetes-obesity in mice. Diabetologia 1979; 14:141–148.

    Article  Google Scholar 

  9. Pi-Sunyer X.Guidelines for the approval and use of obesity drugs. Obes Res 1995; 3:473–478.

    Google Scholar 

  10. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6:51S–209S.

    Google Scholar 

  11. WHO Consultation. Preventing and managing the global epidemic of obesity: report of a WHO Consultation on Obesity. Geneva, 3–5 June, 1997. Geneva, Switzerland: WHO/NUT/NCD98.1, 1998.

    Google Scholar 

  12. Kissebach AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54:254–260.

    Article  Google Scholar 

  13. Misra A. Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. Int J Obes Relat Metab Disord 2003; 27:1294–1296.

    Article  CAS  Google Scholar 

  14. Stevens J. Ethnic-specific revisions of body mass index cutoffs to define overweight and obesity in Asians are not warranted. Int J Obes Relat Metab Disord 2003; 27:1297–1299.

    Article  CAS  Google Scholar 

  15. Valle-Jones JC, Brodie NH, O’Hara H, O’Hara J, McGhie RL. A comparative study of phentermine and diethylpropion in the treatment of obese patients in general practice. Pharmatherapeut 1983; 3:300–304.

    CAS  Google Scholar 

  16. Scoville BA. Review of amphetamine-like drugs by the Food and Drug Administration. In: Bray GA, ed. Obesity in perspective. Fogarty International Center for Advanced Studies in the Health Sciences, Series on Preventive Medicine, Vol. II. Washington, DC: US Government Printing Office, 1976, pp. 441–443.

    Google Scholar 

  17. Silverstone T. Appetite suppressants: a review. Drugs 1992; 43:820–836.

    CAS  Google Scholar 

  18. Goldstein DJ, Potvin JH. Long-term weight loss: the effect of pharmacologic agents. Am J Clin Nutr 1994; 60:647–657.

    CAS  Google Scholar 

  19. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337:581–588.

    Article  CAS  Google Scholar 

  20. Gardin JM, Schumacher D, Constantine G, Davis KD, Leung C, Reid CL. Valvular abnormalities and cardiovascular status following exposure to dexfenfluramine or phentermine/fenfluramine. JAMA 2000; 283:1703–1709.

    Article  CAS  Google Scholar 

  21. Weissman NJ. Appetite suppressants and valvular heart disease. Am J Med Sci 2001; 321:285–291.

    Article  CAS  Google Scholar 

  22. Tellier P. Fenfluramines, idiopathic pulmonary primary hypertension and cardiac valve disorders: facts and artifacts. Ann Med Interne (Paris) 2001; 152:429–436.

    CAS  Google Scholar 

  23. Dhurandhar NV, Atkinson RL. Comparison of serotonin agonists in combination with phentermine for treatment of obesity. FASEB J 1996; 10:A561.

    Google Scholar 

  24. Goldstein DJ, Rampey AH Jr, Dornseif BE, Levine LR, Potvin JH, Fludzinski LA. Fluoxetine: a randomized clinical trial in the maintenance of weight loss. Obes Res 1993; 1:92–98.

    CAS  Google Scholar 

  25. Goldstein DJ, Rampey AH Jr, Roback PJ, et al. Efficacy and safety of long-term fluoxetine treatment of obesity-maximizing success. Obes Res 1995; 3:481S–490S.

    CAS  Google Scholar 

  26. Wadden TA, Bartlett SJ, Foster GD, et al. Sertraline and relapse prevention training following treatment by very low-calorie diet: a controlled clinical trial. Obes Res 1995; 3:549–557.

    CAS  Google Scholar 

  27. Ricca V, Mannucci E, Di Bernardo M, Rizzello SM, Cabras PL, Rotella CM. Sertraline enhances the effects of cognitive-behavioral treatment on weight reduction of obese patients. J Endocrinol Invest 1996; 19: 727–733.

    CAS  Google Scholar 

  28. Griffen L, Anchors M. The “phen-pro” diet drug combination is not associated with valvular heart disease. Arch Intern Med 1998; 158:1278–1279.

    Article  CAS  Google Scholar 

  29. Anchors M. Safer than phen-fen. Rocklin, CA: Prima Publishing, 1997.

    Google Scholar 

  30. Anchors M. Fluoxetine is a safer alternative to fenfluramine in the medical treatment of obesity. Arch Intern Med 1997; 157:1270.

    Article  CAS  Google Scholar 

  31. Ryan DH, Kaiser P, Bray GA. Sibutramine: a novel new agent for obesity treatment. Obes Res 1995; 3:553S–559S.

    CAS  Google Scholar 

  32. Heal DJ, Aspley S, Prow MR, Jackson HC, Martin KF, Cheetham SC. Sibutramine: a novel anti-obesity drug. A review of the pharmacological evidence to differentiate it from D-amphetamine and D-fenfluramine. Int J Obes 1998; 22:S18–28.

    CAS  Google Scholar 

  33. Daly PA, Krieger DR, Dulloo AG, Young JB, Landsberg L. Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity. Int J Obes 1993; 17:S73–78.

    Google Scholar 

  34. Toubro S, Astrup AV, Breum L, Quaade F. Safety and efficacy of long-term treatment with ephedrine, caffeine, and an ephedrine/caffeine mixture. Int J Obes 1993; 17:S69–S72.

    Google Scholar 

  35. Dulloo AG. Ephedrine, xanthines and prostaglandin-inhibitors: actions and interactions in the stimulation of thermogenesis. Int J Obes 1993; 17:S35–S40.

    CAS  Google Scholar 

  36. Arner P. Adenosine, prostaglandins and phosphodiesterase as targeted for obesity pharmacotherapy. Int J Obes 1993; 17(Suppl 1):S57–S59.

    Google Scholar 

  37. Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon JL. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25: 316–324.

    Article  CAS  Google Scholar 

  38. Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002; 26:593–604.

    Article  CAS  Google Scholar 

  39. Anderson JW, Greenway FL, Fujioka K, Gadde KM, McKenney J, O’Neil PM. Bupropion SR enhances weight loss: a 48-week double-blind, placebo-controlled trial. Obes Res 2002; 10:633–641.

    CAS  Google Scholar 

  40. Bray GA, Hollander P, Klein S, Kushner R, Levy B, Fitchet M, Perry BH. A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes Res 2003; 11: 722–733.

    CAS  Google Scholar 

  41. Gadde KM, Franciscy DM, Wagner HR 2nd, Krishnan KR. Zonisamide for weight loss in obese adults: a randomized controlled trial. JAMA 2003; 289:1820–1825.

    Article  CAS  Google Scholar 

  42. Drent ML, van der Veen EA. First clinical studies with orlistat: a short review. Obes Res 1995; 3:623S–625S.

    CAS  Google Scholar 

  43. James WP, Avenell A, Broom J, Whitehead J. A one year trial to assess the value of orlistat in the management of obesity. Int J Obesity 1997; 21:S24–S30.

    CAS  Google Scholar 

  44. Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 1998; 352: 167–172.

    Article  CAS  Google Scholar 

  45. Tonstad S, Pometta D, Erkelens DW, et al. The effect of the gastrointestinal lipase inhibitor, orlistat, on serum lipids and lipoproteins in patients with primary hyperlipidaemia. Eur J Clin Pharmacol 1994; 46: 405–410.

    Article  CAS  Google Scholar 

  46. Lucas CP, Boldrin MN, Reaven GM. Effect of orlistat added to diet (30% of calories from fat) on plasma lipids, glucose, and insulin in obese patients with hypercholesterolemia. Am J Cardiol 2003; 91:961–964.

    Article  CAS  Google Scholar 

  47. Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diab Care 1998; 21:1288–1294.

    Article  CAS  Google Scholar 

  48. McDuffie JR, Calis KA, Uwaifo GI, et al. Three-month tolerability of orlistat in adolescents with obesity-related comorbid conditions. Obes Res 2002; 10:642–650.

    CAS  Google Scholar 

  49. Berger M. Pharmacological treatment of obesity: digestion and absorption inhibitors-clinical perspective. Am J Clin Nutr 1992; 55:318S–319S.

    CAS  Google Scholar 

  50. Munro JF, MacCuish AC, Wilson EM, Duncan LPJ. Comparison of continuous and intermittent anorectic therapy in obesity. Br Med J 1968; 1:352–354.

    Article  CAS  Google Scholar 

  51. Steel JM, Munro JF, Duncan LJ. A comparative trial of different regimens of fenfluramine and phentermine in obesity. Practitioner 1973; 211:232–236.

    CAS  Google Scholar 

  52. James WP, Astrup A, Finer N, et al. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance. Lancet 2000; 356: 2119–2125.

    Article  CAS  Google Scholar 

  53. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Arnold ME, Steinberg CM. Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: a placebo-controlled trial. Obes Res 2000; 8:431–437.

    Article  CAS  Google Scholar 

  54. Padwal R, Li S, Lau D. Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev 2003; 4:CD004094.

    Google Scholar 

  55. Sayler ME, Goldstein DJ, Roback PJ, Atkinson RL. Evaluating success of weight loss programs, with an application to fluoxetine weight reduction clinical trial data. Int J Obes Relat Metab Disord 1994; 18: 742–751.

    CAS  Google Scholar 

  56. Greenway FL. Clinical studies with phenylpropanolamine: a metaanalysis. Am J Clin Nutr 1992, 55: 203S–205S.

    CAS  Google Scholar 

  57. Greenway F, Herber D, Raum W, Herber D, Morales S. Double-blind, randomized, placebo controlled clinical trials with non-prescription medications for the treatment of obesity. Obes Res 1999; 7:370–378.

    CAS  Google Scholar 

  58. Weintraub M, Hasday JD, Mushlin AI, Lockwood DH. A double blind clinical trial in weight control: use of fenfluramine and phentermine alone and in combination. Arch Intern Med 1984; 144:1143–1148.

    Article  CAS  Google Scholar 

  59. Weintraub M. Long-term weight control: the National Heart, Lung, and Blood Institute funded multimodal intervention study. Clin Pharmacol Ther 1992; 51:581–646.

    Article  CAS  Google Scholar 

  60. Atkinson RL, Blank RC, Schumacher D, Dhurandhar NV, Ritch DL. Long-term drug treatment of obesity in a private practice setting. Obesity Research 1997; 5:578–586.

    CAS  Google Scholar 

  61. Hartley GG, Nicol S, Halstenson C, Khan M, Pheley A. Phentermine, fenfluramine, diet, behavior modification, and exercise for treatment of obesity. Obes Res 1995; 3:340s.

    Google Scholar 

  62. Pedrinola F, Sztejnsznajd C, Lima N, Halpern A, Medeiros-Neto G. The addition of dexfenfluramine to fluoxetine in the treatment of obesity: a randomized clinical trial. Obes Res 1996; 4:549–554.

    CAS  Google Scholar 

  63. Devlin MJ, Goldfein JA, Carino JS, Wolk SL. Open treatment of overweight binge eaters with phentermine and fluoxetine as an adjunct to cognitive-behavioral therapy. Int J Eat Disord 2000; 28:325–332.

    Article  CAS  Google Scholar 

  64. Molnar D, Torok K, Erhardt E, Jeges S. Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents. Int J Obes Relat Metab Disord 2000; 24:1573–1578.

    Article  CAS  Google Scholar 

  65. Kalman D, Incledon T, Gaunaurd I, Schwartz H, Krieger D. An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes Relat Metab Disord 2002; 26:1363–1366.

    Article  CAS  Google Scholar 

  66. Paul Shekelle, Hardy M, Morton SC, et al. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Rand Corporation, AHRQ Publication No. 03-E022, Contract No. 290-97-0001, Task Order No. 9, February 2003.

    Google Scholar 

  67. Greenway FL. The safety and efficacy of pharmaceutical and herbal caffeine and ephedrine use as a weight loss agent. Obes Rev 2001; 2:199–211.

    Article  CAS  Google Scholar 

  68. Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003; 289:1537–1545.

    Article  CAS  Google Scholar 

  69. FDA Press Release. FDA Announces Plans to Prohibit Sales of Dietary Supplements Containing Ephedra. Website: (http://www.fda.gov/oc/initiatives/ephedra/december2003).

    Google Scholar 

  70. Brenot F, Herve P, Petitpretz P, Parent F, Duroux P, Simonneau G. Primary pulmonary hypertension and fenfluramine use. Br Heart J 1993; 70:537–541.

    Article  CAS  Google Scholar 

  71. Abenhaim L, Moride Y, Brenot F, et al. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. N Engl J Med 1996; 335:609–616.

    Article  CAS  Google Scholar 

  72. Manson JE, Faich GA. Pharmacotherapy for obesity-do the benefits outweigh the risks? N Engl J Med 1996; 335:659–660.

    Article  CAS  Google Scholar 

  73. Dhurandhar NV, Atkinson RL. Appetite-suppressant drugs and primary pulmonary hypertension. N Engl J Med 1997; 336:511.

    CAS  Google Scholar 

  74. Pi-Sunyer X. The NAASO position paper on approval and use of drugs to treat obesity. Obes Res 1995; 3:471–472.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Obtech Inc., Richmond, VA

    Richard L. Atkinson MD

  2. Obesity Institute, MedStar Research Institute, Washington, DC

    Richard L. Atkinson MD & Gabriel Uwaifo MD

Authors
  1. Richard L. Atkinson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriel Uwaifo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Pharmacology and Toxicology, Indiana University School of Medicine and PRN Consulting, Indianapolis, IN

    David J. Goldstein MD, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc.,Totowa,NJ

About this chapter

Cite this chapter

Atkinson, R.L., Uwaifo, G. (2005). Combination Therapies for Obesity. In: Goldstein, D.J. (eds) The Management of Eating Disorders and Obesity. Nutrition and Health. Humana Press. https://doi.org/10.1385/1-59259-865-X:277

Download citation

  • DOI: https://doi.org/10.1385/1-59259-865-X:277

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-341-1

  • Online ISBN: 978-1-59259-865-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation