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Abstract
In response to the increase in obesity, pharmacologic treatments for weight loss have
become more numerous and more commonly used.
To assess the efficacy and safety of weight loss medications approved by the U.S.
Food and Drug Administration and other medications that have been used for weight
loss.
Electronic databases, experts in the field, and unpublished information.
Up-to-date meta-analyses of sibutramine, phentermine, and diethylpropion were identified.
The authors assessed in detail 50 studies of orlistat, 13 studies of fluoxetine, 5
studies of bupropion, 9 studies of topiramate, and 1 study each of sertraline and
zonisamide. Meta-analysis was performed for all medications except sertraline, zonisamide,
and fluoxetine, which are summarized narratively.
The authors abstracted information about study design, intervention, co-interventions,
population, outcomes, and methodologic quality, as well as weight loss and adverse
events from controlled trials of medication.
All pooled weight loss values are reported relative to placebo. A meta-analysis of
sibutramine reported a mean difference in weight loss of 4.45 kg (95% CI, 3.62 to
5.29 kg) at 12 months. In the meta-analysis of orlistat, the estimate of the mean
weight loss for orlistat-treated patients was 2.89 kg (CI, 2.27 to 3.51 kg) at 12
months. A recent meta-analysis of phentermine and diethylpropion reported pooled mean
differences in weight loss at 6 months of 3.6 kg (CI, 0.6 to 6.0 kg) for phentermine-treated
patients and 3.0 kg (CI, -1.6 to 11.5 kg) for diethylpropion-treated patients. Weight
loss in fluoxetine studies ranged from 14.5 kg of weight lost to 0.4 kg of weight
gained at 12 or more months. For bupropion, 2.77 kg (CI, 1.1 to 4.5 kg) of weight
was lost at 6 to 12 months. Weight loss due to topiramate at 6 months was 6.5% (CI,
4.8% to 8.3%) of pretreatment weight. With one exception, long-term studies of health
outcomes were lacking. Significant side effects that varied by drug were reported.
Publication bias may exist despite a comprehensive search and despite the lack of
statistical evidence for the existence of bias. Evidence of heterogeneity was observed
for all meta-analyses.
Sibutramine, orlistat, phentermine, probably diethylpropion, bupropion, probably fluoxetine,
and topiramate promote modest weight loss when given along with recommendations for
diet. Sibutramine and orlistat are the 2 most-studied drugs.
[1
]From the Southern California Evidence-Based Practice Center, which includes RAND Health
Division, Santa Monica, and the Greater Los Angeles VA Healthcare System, Los Angeles,
California; and Department of Veterans Affairs, Cincinnati, Ohio.