With the dearth of long-term successful treatments for obesity, practitioners need to be inventive in order to induce significant weight loss. More drugs are being banned than licensed, and calorie counting, low-fat approaches and fad diets are being shown to be ineffectual in sustaining weight loss.
Very low energy diets (VLEDs; or very low calorie diets) have consistently been shown to induce safe weight loss of a degree only paralleled by bariatric surgery, but there is a suspicion that weight regain is a common long-term outcome. Weight loss programmes tend to consist of one single intervention (e.g. Weight Watchers or Slimming World or LighterLife or orlistat, and so on). Even Tier 3 services will try a VLED, then try cognitive behavioural therapy if the diet is unsuccessful.
The concept of combining two different modalities simultaneously is often anathema. Whereas, in the management of blood pressure, for instance, the use of different modalities is almost invariable: prescribing two or more drugs, and advising to reduce salt-containing foods and to optimise physical activity. Trials by researchers such as Tom Wadden have shown that, for instance, behavioural therapy had a limited effect and sibutramine had a small, but useful, effect, but together they induced an impressive weight loss.
The paper summarised alongside is not well written, is incomplete (it discusses taranabant – which never made it to launch – but not rimonabant), flawed (VLEDs are perfectly safe, and widely recommended for individuals with BMI <32 kg/m2), disorganised and chaotic. It only discusses six papers from over 40 years, each using different pharmacological agents: four of which induced weight loss and two which didn’t. The pharmacological agent in question is only revealed in the two unsuccessful trials, so we are shown a 10 kg loss without knowing the drug involved. Apart from a few confusing tables of completer analyses, there are no graphs of weight loss over time. Nevertheless, it serves to remind clinicians that, in diabesity, it is worth considering combinations of interventions.
VLEDs can be initiated in clinic and are good interventions for rapid weight loss, and drugs are moderately successful, although few survive. Putting the two together = very effective. Until the day the anti-obesity magic bullet arrives, more adventurous combinations of interventions for diabesity might work.
To view the summaries of each paper, please download the PDF of this article.
