Sequencing of behavior therapy and pharmacotherapy for obesity

Investigated 2 sequences of combining behavior therapy and pharmacotherapy to determine if anorexic medication could be used effectively to facilitate initial weight loss without compromising the long-term effects of behavior therapy. 91 18-30 yr old women, averaging 31% overweight, participated in a 16-wk treatment program with follow-up assessments scheduled 4 mo and 1 yr later. Anorexic medication, fenfluramine HCl, enhanced weight loss whenever it was introduced, but it was more effective when introduced 8 wks into the behavior therapy program rather than initially. Ss in this sequence (later medication) had lost the most weight (9.3 kg) by the end of treatment, significantly more than those receiving either medication or behavior therapy only. These Ss, however, regained weight once treatment was terminated so that by the 1-yr follow-up, the conditions were not significantly different. Ss in the other sequence (initial medication) maintained their weight loss after medication was terminated as long as they continued to receive behavior therapy; however, they too regained weight once all treatment was terminated. Thus, anorexic medication demonstrated a surprisingly strong effect when introduced midway through a behavior therapy program, when the rate of loss typically slows, but this initially beneficial effect was not maintained during the follow-up period. A post hoc exploration of the data indicates that medication was particularly helpful to Ss who did not initially respond well to behavior therapy. (13 ref)