Incorporating evidence-based approaches to reducing obesity—including screening, counseling, medication, and surgery, when appropriate—may be effective in managing obesity.
This clinician's aid highlights research from AHRQ's evidence-based practice program. This research informs many science-based recommendations in the public and private sector, including the U.S. Preventive Services Task Force (USPSTF).
The mission of AHRQ is to improve the quality, safety, efficiency, and effectiveness of health care by:
Obesity is a risk factor for heart disease, type II diabetes, hypertension and stroke, hyperlipidemia, osteoarthritis, sleep apnea, and cancer. Even modest weight loss can reduce the risk of these diseases.
Medication, Dosage | Weight Loss1 By Time | Side Effects | Relative Risk Compared with Placebo |
---|---|---|---|
Bupropion 400 mg/day |
1-5 kg, 6-12 mo | Dry mouth Diarrhea Constipation Upper respiratory problems |
2.3 1.3 1.3 1.1 |
Diethylpropion 75 mg/day |
2-12 kg, 6-12 mo | NR | NR |
Fluoxetine 60 mg/day |
3-7 kg, 6 mo 1-6 kg, 12 mo |
Nervousness/sweating/tremors Nausea/vomiting/fatigue/asthenia Hypersomnia/somnolence Insomnia Diarrhea |
6.4 2.7 2.4 2.0 1.7 |
Orlistat (Dosage NR) |
2-3 kg, 6 mo 2-3 kg, 12 mo |
Diarrhea Flatulence Bloating/abdominal pain/dyspepsia |
3.4 3.1 1.5 |
Phentermine 15-30 mg/day |
1-6 kg, 6 mo | NR, but can expect: Palpitations Tachycardia Elevated blood pressure Central nervous system effects Gastrointestinal effects Case reports of stroke have been reported but causality cannot be assumed. |
NR |
Sibutramine 10 or 20 mg/day |
4-6 kg, 4-6 mo 4-5 kg, 12 mo |
Modest increases in heart rate and blood pressure | NR |
Topiramate 96-192 mg/day |
5-8 kg, 6 mo | Taste perversion Paraesthesia Constipation Dry mouth Central nervous system effects Upper abdominal symptoms Fatigue Upper respiratory problems Diarrhea |
9.2 4.9 3.5 2.9 2.0 1.6 1.3 1.2 1.0 |
Zonisamide 100-600 mg/day |
6% of baseline body weight, 4 mo | Fatigue | NR |
1 Weight loss estimates based on a 95% confidence interval. |
This clinician's aid is based on the following work supported by the Agency for Healthcare Research and Quality (AHRQ):
Shekelle PG, Morton SC, Maglione M, et al. Pharmacological and Surgical Treatment of Obesity. Evidence Report/Technology Assessment No. 103. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
U.S. Preventive Services Task Force. Screening for obesity in adults: recommendation statement. Ann Intern Med 2003;139(11):930-2.
For more information on AHRQ's Evidence-based Practice Centers, contact Kenneth Fink, M.D., M.G.A., M.P.H., at KFink@ahrq.gov.
Current as of October 2004
AHRQ Publication No. 04-0082
Internet Citation:
Managing Obesity: A Clinician's Aid. AHRQ Publication No. 04-0082, October 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/obesaid.htm
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