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Weight Loss Drug Trial
Sibutramine, Abdominal Obesity and Chronic Metabolic Diseases
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Weight Loss Drug Trial Conclusion

Specialized Obesity Clinics
Though the results of the STORM (sibutramine trial of obesity reduction and maintenance) weight loss drug study are important, they also raise several questions to address in future studies. Firstly, the study used specialized obesity clinics, often in academic settings, and a fairly sophisticated approach: assessment of resting metabolic rate for estimating daily energy needs; adjustment of the recommended energy intake over time to compensate for the body weight loss; dietary supervision every two weeks; and a visit to the treating physician every month. Thus, the results probably do not reflect what could be achieved by most family physicians in routine practice.

Secondly, only the successful weight losers (467/605) took part in the second part of the study. Thus, sibutramine was effective in maintaining reduced body weight so long as the patient had already "responded" to the drug. This result should again be interpreted in the context of routine practice. It may be argued that if a patient does not respond to a weight loss drug after a few months there is little chance that its continued use would be beneficial. Studies that have examined this issue suggest that a period of about three months may be sufficient to identify responders.6-8

Finally, as in most weight loss trials, the vast majority of patients enrolled (over 80%) were women. Though this reflects the population of patients treated in most obesity clinics around the world, men are generally characterised by a more dangerous form of obesity - visceral, or abdominal, obesity. The current tragedy in medical practice is that neither obese men nor their doctors recognise the tremendous hazards of abdominal obesity. In the STORM study sibutramine therapy for two years reduced the waist circumference (the best crude index of abdominal fat accumulation) by more than 9 cm while also improving the cardiovascular risk profile. However, as the sample consisted largely of women with only moderate deterioration in their cardiovascular risk profile, even greater improvement in cardiovascular risk might have been observed in abdominally obese men.

Weight Loss Drug Trial Summary
In summary, the successful findings of the STORM study should pave the way to the design of long term randomised trials in high risk abdominally obese patients. Future trials should include proper evaluation of the impact of such weight loss drug treatment on the risk of developing prevalent chronic metabolic diseases such as type 2 diabetes and cardiovascular diseases.

Source: bmj journals

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