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Combating Obesity: Updates on Dieting & Pharmacologic Appetite Control
Gregory M. Weiss, MD
Three new studies from Obesity Week 2018 highlight non-surgical weight loss strategies for obese patients.
Three recent abstracts presented at Obesity Week 2018 highlight non-surgical weight loss strategies for obese patients including both pharmacologic and dietary approaches. In the first study, Kristina Lewis, MD, MPH, SM, and colleagues found that initiating a low calorie diet (LCD) over time vs abruptly has no effect on weight loss trajectories. In the second study, Jena Tronieri, PhD, and colleagues discovered that intensive behavioral therapy combined with liraglutide led to significantly greater weight loss than behavioral therapy alone but no long term differences in hunger or fullness. In the third study, Judy Loper, PhD, RDN, and fellow researchers found that following a very low calorie diet in combination with phentermine treatment led to significant weight loss and maintenance down the road.
Click through the slides for details on the studies and take home points for clinical practice.
Study 1. Authors sought to determine if tapering calories over time reduces hunger and allows for longer-term maintenance of weight loss.
Methods and Results. This 24-week randomized pilot feeding study looked at 20 adults with a BMI of 30-39.9 kg/m2 who were not taking weight loss drugs nor have had weight loss surgery. Subjects were randomized to abrupt reduction in calories or gradually tapered arm. Mean weight loss was similar in both groups at weeks 6, 12, and 24. Taper group had larger increases in self-reported hunger vs abrupt LCD at weeks 6, 12, and 24. Taper group also experienced significant decrease in fasting ghrelin at 24 weeks vs abrupt reduction group.
Take Home Points. Slowly tapering calorie intake does not change how much weight loss patients experience vs abruptly cutting calories. Patients who choose to taper caloric intake over time may experience more hunger vs those who are abruptly cutting intake even though hunger hormone levels decrease. Physicians should continue to promote LCD for obese patients.
For more information: Lewis K, Miller GD, Dibert LC, et al. Tapering energy intake: A novel approach to dieting? Weight change and hunger during weight loss. Poster presented at: Obesity Week 2018; November 2018; Nashville, TN.
Study 2. Authors hypothesized that medication-assisted treatment may be effective for patients who are not able to lose weight with behavioral therapies or have uncontrolled hunger.
Methods and Results. This randomized, controlled trial looked at 150 obese adults over a 52 week period and assigned each to receive 1 of 3 interventions: IBT-alone, IBT-liraglutide, or multi-component. IBT-liraglutide had significantly larger reductions at week 6 in hunger and food preoccupation and larger increases in fullness vs IBT-alone. However, at week 52, there were no differences among any of the groups.
Take Home Points. Physicians should consider using liraglutide with behavioral therapy since the combination produced significant weight loss. While IBT-liraglutide reduced hunger and produced fullness in the short term, the effect was not maintained at 52 weeks. Adding a meal-replacement plan may further increase the amount of weight lost when combined with IBT-liraglutide. IBT-liraglutide may lead to improvements in cardiovascular risk factors associated with weight.
For more information: Tronieri J, Wadden TA, Berkowitz RI, et al. Effect of liraglutide on appetite, liking, and preoccupation with food in a randomized trial. Poster presented at: Obesity Week 2018; November 2018; Nashville, TN.
Study 3. Authors sought to examine the role of VLCD, the efficacy of phentermine added to LCD, and lifestyle change in weight maintenance for up to 5 years in obese patients.
Methods and Results. The study consisted of 523 adults who were given either Optifast TM low calorie drinks or a food based VLCD. After 8 weeks, the subjects transitioned to LCD and prescribed phentermine with regular follow-up visits with a dietitian. At the end of year 1, there was a 15.2% weight loss in 218 subjects and at the end of year 2, there was a 12.5% weight loss in 102 subjects.
Results, cont'd. At the end of year 3, there was a 9% weight loss in 59 subjects; at the end of year 4, there was a 7.9% weight loss in 34 subjects; at the end of year 5, there was a 7.2% weight loss in 24 subjects.
Take Home Points. Patients who complied with VLCD initially and phentermine therapy later in the study saw medically significant weight loss. Although there was a significant drop over time, subjects that completed 3-5 years of follow-up still had clinically meaningful weight loss. Physicians should consider a 2 pronged approach, LCD plus phentermine, for obese patients but still encourage follow-up and treatment adherence.
For more information: Loper JF, Broyles JT, May R, Baltes EJ. Very low calorie diet followed by phentermine for maintenance. Poster presented at: Obesity Week 2018; November 2018; Nashville, TN.
Perspective. “We present 3 studies here that highlight the importance of behavioral therapy and pharmacologic supplementation for long-term weight loss in obese patients. While bariatric surgical procedures are proven to help obese patients lose weight initially, the authors of these abstracts focus on maintenance of weight loss which can be very elusive. While these results are promising, large drop out rates and lack of sustained results underscore the crucial importance of long term clinician involvement to promote adherence and provide support to their patients fighting obesity.”