Orlistat plus behavioral programs may bring greater weight loss

Weight-loss methods abound, but which ones are most effective? A meta-analysis finds weight-loss programs that include behavioral interventions by themselves or with medication can be a safe and helpful way to lose weight.

The study, released Monday in the Annals of Internal Medicine, analyzed 38 behavior-based studies, 18 studies that included a behavioral component plus orlistat, and three studies that combined a behavioral program with metformin. Orlistat is a weight-loss drug available by prescription or over the counter (as Alli), and metformin is typically prescribed to treat Type 2 diabetes.

Average weight lost in the behavior-based studies was about nine to 15 pounds in at least 12 to 26 sessions in the first year; control groups lost almost no weight. Adding orlistat into the mix resulted in an 11- to 22-pound weight loss versus seven to 13 with a placebo. The metformin plus behavioral program groups lost the least weight, four to nine pounds. The more treatment sessions, the more weight loss was seen.

In all studies that included some sort of intervention, the risk of diabetes was reduced. Behavior-based programs that lasted for seven to 23 sessions in the first year and produced a weight loss of 8.8 to 15.4 pounds reduced the occurrence of diabetes by about 50% or more over a two- to three-year span.

In general the behavioral weight-loss programs were safe, but there was incomplete safety information in the trials that involved drugs. “Long-term weight and health outcomes data were lacking and should be a high priority for future study,” the authors wrote.