OBJECTIVE To assess weight loss, as well as the prevalence of valvular heart disease, in 21 obese women who completed 2 years of treatment by fenfluramine and phentermine (fen-phen) in June 1997. RESEARCH METHODS AND PROCEDURES Patients were 21 of 22 women who had completed a 1-year, open-label trial of fen-phen combined with lifestyle modification. This study describes the results of a second year of treatment. The presence of valvular heart disease, defined as aortic regurgitation of mild or greater severity and/or mitral regurgitation of moderate or greater severity, was assessed using two-dimensional, color Doppler and pulsed- and continuous-wave Doppler examinations. RESULTS At 2 years, the 21 patients had a mean reduction in initial weight of 13.9 + 10.0%, which was significantly (p<0.001) smaller than their 1-year loss of 17.1 +/- 8.7%. Nine of 21 patients reported that they took fen-phen irregularly during the last 4 months of the study because of fears of developing health complications. These nine patients had a 2-year weight loss of 8.7 +/- 7.5%, compared with a significantly (p<0.04) larger loss of 17.6 +/- 10.5% for participants who reported taking medication regularly. Six of 20 (30%) patients met criteria for valvular heart disease. None of the six had signs or symptoms of this condition. DISCUSSION Fenfluramine was withdrawn from the market on September 15, 1997 because of concerns that it was associated with valvular heart disease. The present findings are discussed in terms of the potentially favorable long-term benefits of combining lifestyle modification with weight loss medications that are both safe and effective.

This study examined a new method of providing brief, individual lifestyle modification to obese individuals treated by pharmacotherapy. Twenty-six women with a mean (+/- SD) age of 47.0 +/- 7.2 years, weight of 97.6 +/- 13.0 kg, and body mass index of 36.5 +/- 5.0 kg/m2 were prescribed 60 mg/d of fenfluramine and 15 mg/d of phentermine for one year. In addition, half of the women were randomly assigned to traditional group behavior modification, conducted by a nutritionist, which included 32 75-minute sessions during the year. The other half were provided lifestyle modification by a physician during 10 15-20 minute structured visits. All participants received identical treatment manuals and comparable assignments for behavior change. At the end of one year, patients in the physician group achieved the same highly successful weight losses as those treated by group behavior modification (13.9 +/- 9.6 kg vs. 15.4 +/- 7.9 kg, respectively). Treatment was associated with highly significant improvements in lipids and lipoproteins, as well as in mood and several measures of appetite. Weight loss the first four weeks, as well as patient completion of daily food records during the first 18 weeks, correlated positively with weight loss at weeks 18, 26, and 52. Results of this study await replication using larger samples but strongly suggest that effective lifestyle modification can be provided during brief, structured physician visits. The findings are discussed in terms of their implications for the treatment of obesity in primary care practice.

This study examined the combination of sertraline, a selective serotonin reuptake inhibitor, and relapse prevention training in the maintenance of weight loss following treatment by a very-low-calorie diet. A total of 53 women who had lost a mean (+/- SD) of 22.9 +/- 7.1 kg from a pretreatment weight of 103.1 +/- 17.8 kg were randomly assigned to a 54-week weight maintenance program that was combined with either: 1) 200 mg/d of sertraline; or 2) placebo. During the first 6 weeks, sertraline subjects lost significantly more weight and reported significantly greater reductions in hunger and preoccupation with food than did subjects on placebo. After this time, however, women in both conditions regained weight steadily. The 13 sertraline subjects who completed the 54-week study regained 17.7 +/- 10.6 kg of their original 26.3 +/- 7.6 kg loss, equal to a regain of 70.9 +/- 41.7%. The 17 placebo completers regained 11.8 +/- 9.0 kg of their 23.4 +/- 7.8 kg loss, equal to a 46.5 +/- 34.6% regain. End-of-treatment differences between groups in weight change were not statistically significant. Nor were there significant differences between the two conditions at any time in changes in fat-free mass, resting metabolic rate or dysphoria, all of which tended to increase with weight regain. The results are discussed in relation to findings from other long-term studies that combined diet and medication.

Background. - Congressional hearings initiated in March 1990 revealed that America's $10 billion a year weight loss industry is subject to minimal regulation by federal agencies. Consumers are forced to rely on advertisements and testimonials when selecting treatment because no proprietary program has provided a prospective assessment of its short- and long-term results of treatment. This report describes such an assessment.Methods. - A total of 517 obese patients (407 women and 110 men) participated in a proprietary program that included 12 weeks of treatment by very-low-calorie diet within a 26-week program of life-style modification. Patients were treated in two cohorts (6 months apart) according to a standardized protocol implemented at 18 hospital-based clinics across the nation.Results. - Fifty-six percent of women and 54% of men completed treatment, at which time their weight losses (mean +/- SEM) were 22.0 +/- 0.6 and 32.1 +/- 1.4 kg, respectively. Weight losses of women and men who discontinued treatment averaged 14.3 +/- 0.7 and 20.0 +/- 1.6 kg, respectively. Weight loss was associated with significant improvements in blood pressure and total serum cholesterol levels. A 1-year follow-up evaluation of 74% of patients in the second cohort who completed treatment revealed that they maintained 15.3 +/- 1.2 of their 24.8 +/- 1.0-kg end-of-treatment weight loss; 59% of patients maintained a loss of 10 kg or more.Conclusion. - We hope that this report will lead to the systematic evaluation of other proprietary weight loss programs and to the publication of findings that will permit consumers to make informed treatment decisions.

Surprisingly, until the very recent past almost nothing had been known about genetic influences on human obesity. The powerful genetic effects described with such assurance in the textbooks were based almost entirely on extrapolation from animal studies. The first strong evidence of genetic influence on human obesity was obtained from an adoption study in Denmark that showed a high correlation of the body mass index of adoptees with that of their biological parents and no correlation with that of their adoptive parents. The body mass index of the adoptees was also highly correlated with that of their siblings and showed evidence of recessive transmission. These findings have been extended by a twin study that revealed very high heritabilities at both age 20 and age 45. A bivariate analysis of the identical twins of this population revealed high intrapair correlations among the normal weight twins and low correlations among the obese twins distributions, suggesting a strong environmental influence on the genetically vulnerable obese twins. The best estimate of heritability, the correlation coefficient of 93 identical twin pairs reared apart, from the Swedish Adoption Study of Aging, revealed high levels of heritability, indicating that traditional twin studies have overestimated the heritability of body mass index only slightly, if at all.

Computerized tomography (CT) was used to assess the effect of a loss of body weight (18.8 kg) on the size of five fat depots in 11 obese postmenopausal women: the abdominal subcutaneous and visceral depots, the pelvic subcutaneous and intrapelvic depots, and the thigh subcutaneous depot. The mean decrease in total body fat was 34 percent, with comparable decreases in total abdominal fat (33 percent) and total pelvic fat (32 percent). In the abdomen, visceral fat was reduced by 35 percent and subcutaneous fat by 33 percent. In the pelvic region, intrapelvic fat decreased by 51 percent and subcutaneous fat by 25 percent. The decrease in the size of the abdominal visceral fat depot was highly correlated with fat loss during treatment (r = 0.68). By contrast, the decrease in the size of the subcutaneous abdominal fat depot correlated less highly with fat loss. These preliminary findings suggest that obese postmenopausal women with large visceral fat depots will decrease the size of their visceral fat depots by weight reduction. This is good news since the adverse health effects of obesity are believed to be associated with visceral fat.

This study examined psychological functioning and satisfaction with weight and figure in a total of 393 obese and nonobese adolescent girls from lower-middle to middle-class families. No significant differences were observed between the two groups on measures of trait anxiety or depression, and all subjects scored well within normal limits. Obese girls did, however, report significantly greater dissatisfaction with their weight and figure than did nonobese girls. Many nonobese girls also expressed dissatisfaction with their weight, supporting the view that women's dissatisfaction with weight is a 'normative discontent'. Nearly 70 percent of the total sample had attempted to lose weight in the past year. The results of this study indicate that obese girls in the general population are dissatisfied with their weight but are not significantly anxious or depressed, as had been suggested by studies of overweight adolescents in clinical settings.