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Non-surgical Medical Treatment Programs Effective for Weight Loss in Morbidly Obese

February 2, 2010 - Medical treatment programs can be instrumental in helping patients who are morbidly obese to lose weight and keep it off, according to a study published January 25 in the Archives of Internal Medicine.

These non-surgical programs are available at Adelaide Obesity Surgery (SA) and Innovations Healthcare (NT Darwin & Alice Springs) for patients who need a physician-guided program but are not ready to take the step to weight loss surgery. These programs are delivered with the full support of our multi-disciplinary team, including dietitian, psychologist, and exercise physiologist, with the doctor maintaining a strategic overview of the programme. This program is a scientific approach which offers an alternative to activities undertaken by commercial weight-loss centres & organizations, many of which have no medical evidence to support their offerings.

The medical treatment programmme recently published by Donna H. Ryan, MD, from the Pennington Biomedical Research Center, Baton Rouge, Louisiana, and colleagues is very similar to that developed at Adelaide Obesity Surgery & Innovations Healthcare. She said "we developed the Louisiana Obese Subjects Study (LOSS) to test the hypothesis that primary care physicians could effectively implement intensive medical management to treat patients with extreme obesity, with a goal of weight loss at year 2 significantly better than usual care."

LOSS, a randomized controlled pragmatic clinical trial, took place from July 2005 through January 2008. Volunteers, 83% of whom were women, BMI of 40 - 60 and a mean age of 47 years. They were divided into 2 groups: intensive medical intervention (IMI; n = 200) and usual care condition (UCC; n = 190). The UCC group was directed to an Internet weight loss program. The medical treatment program followed these recommendations:

• Maintain a 900-kcal liquid diet for up to 12 weeks.
• Attend group behavioral counseling, follow a standardized diet and exercise program, and take weight-loss medications (choice of sibutramine hydrochloride, orlistat, or diethylpropion hydrochloride) during months 3 through 7.
• Continue medications and adhere to maintenance methods for months 8 through 24.

Medical Support Results in Long-Term Weight Loss After 2 years, the study authors reported that the medical treatment group had lost more weight and maintained their weight loss better than the usual care clients: In the medical treatment group, 31% achieved a weight loss of 5% or more, and 7% achieved a 20% or greater weight loss vs 9% and 1%, respectively, in the usual care group. The results were statistically significant at year 2 for all group differences, according to the study authors.

"Recently, the SOS [Swedish Obese Subjects] study demonstrated that surgery for obesity is associated with reduction in mortality," the authors write. Surgery may not be an option for some patients with extreme obesity because of cost issues and individual preference.

In an interview with Medscape Diabetes & Endocrinology, John Morton, MD, director of bariatric surgery at Stanford University in Stanford, California, pointed out that "Obesity is a chronic disease and just like any chronic disease it requires a lot of different modalities, including surgery and other medical intervention," Dr. Morton said. "Even a modest amount of weight loss is going to result in some significant health benefits."

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