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Guidelines on Overweight and Obesity: Electronic Textbook
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2.b. Pharmacotherapy Trials


Evidence Statement: Weight loss produced by weight loss medications and adjuvant lifestyle modifications produces no consistent change in blood lipids. Evidence Category B.

Rationale: The effects of pharmacological therapy on weight loss and subsequent changes in total serum cholesterol levels were evaluated by examining eight RCTs (386, 390-393, 395, 407, 408) (Table III-3). The four trials of dexfenfluramine showed no consistent effects on total cholesterol; three trials showed decreases in triglycerides ranging from 14 to 40 percent and two trials showed increases in HDL-cholesterol of 8 percent in women to 27 percent in men. One trial of phentermine plus fenfluramine showed a 24 percent decrease in triglycerides and a slight change in HDL-cholesterol (395). The trial of orlistat showed a decrease in total cholesterol and an increase in triglycerides, while the trial of fluoxetine showed the opposite (407, 408). Other RCTs using orlistat have shown a modest improvement in lipids with weight loss (388). 

In a combined summary of data presented at the FDA Endocrinologic and Metabolic Drugs Advisory Committee Meeting (held in Bethesda, Maryland, in September 1996), use of sibutramine, which resulted in a greater net weight loss of 2.4 kg (5.3 lb) at 4 months, also resulted in modestly lower levels of total cholesterol, LDL-cholesterol, and triglycerides, along with slightly higher HDL-cholesterol levels, compared to placebos (389).

Table III-3: Weight Reduction by Drug Therapy
Study
N, Sex, and Duration
Weight Loss
Percentage Change
TC TG LDL-C HDL-C
Bremer (386) Dexfenfluramine
12 (8M/4F)  experimental
14 (8M/6F) control
12 weeks
-6
-14
-40
-9
+15
Mathus-  Vliegen (391) Dexfenfluramine
17 experimental
18 control
12 months
-4
+7
-14
---
---
O'Connor (392) Dexfenfluramine
27 (6M/21F) experimental
24 (14M/10F) control
6 months
-6
+5
-26
---
+27M 

+8F

Pfohl (393) Dexfenfluramine
19 experimental
15 control
12 months
-2
-3
+26
---
---
Weintraub (395) Fen/Phen
53 Fen/Phen
51 placebo
34 weeks
-13
-6
-24
-2
-1
Drent (407) Orlistat
20 (3M/17F) Orlistat
19 (3M/16F) placebo
12 weeks
-2
-2
+8
---
---
O'Kane (408) Fluoxetine
7 Fluoxetine
9 placebo
-6
+9
-25
---
---
TC=Total Cholesterol  TG=Triglycerides  BMI=Body Mass Index
LDL-C=Low-Density Lipoprotein Cholesterol
HDL-C=High-Density Lipoprotein Cholesterol
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