We have previously reported on the effects of 16 weeks of treatment by sibutramine, meridia for 1 year, combined with either orlistat or placebo, in 34 women who had completed an initial 52 weeks of therapy with sibutramine alone (1,2). Adding orlistat to sibutramine did not increase weight loss. Thus, the two medications did not seem to have additive effects, although there was a trend in this direction for women who lost < 10 % of their initial weight.

The Principal finding of this study is that continued use of medication after weight loss seemed to facilitate weight maintenance, as has been shown in randomized trials of both sibutramine (3,4) and orlistat (5,6). However, fewer than 25% of participants continued to take medication after our 68-week trial concluded, despite our advice that they do so. Patients who discontinued therapy had a significantly poorer outcome. Weight-loss medication only work if patients take them long-term, yet most weight-loss medications prescriptions are filled for fewer than 75 days. This is a serious problem in the pharmacological treatment for obesity and in the management of other chronic conditions. Paradoxically, the patients who discontinued sibutramine at week 68 because they thought it was no longer effective could only fully realize the mediction's benefit after they stopped taking it (and gained 4.7kg during the follow-up period). We must find better ways to help patients understand the potential benefits of long-term pharmacological management of their obesity.

Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Arnold ME, Steinberg CM. Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: a placebo-controlled trial. Obes Res. 2000;8:431-7