Drug therapy after very-low-calorie diets.

Very-low-calorie diets (VLCDs) are effective at reducing weight, even in patients who have often failed with conventional diets. Maintaining weight lost by means of a VLCD remains a clinical challenge. Attempts to prevent weight regain by dietary reeducation or by more formal behavior-modification techniques are not easily applicable to large numbers of patients and are not always successful; the use of drugs to maintain and improve upon initial VLCD success could be of real clinical value. Pharmacological treatment of obesity has evolved in recent years with the development and licensing of potent serotonin agonists, such as dexfenfluramine (dF), acting as nonstimulant anorectic agents. Thermogenic drugs are not yet as advanced in clinical development and evaluation but offer the prospect of increasing energy output in the reduced obese patient. Drugs used to treat obesity need to be effective, to be safe, not to exhibit drug tolerance, and ideally, to be shown to reduce morbidity or mortality from obesity, particularly because treatment will need to be prolonged. Such requirements are not unique for treating obesity, they are similar for drugs used to treat other metabolic diseases such as hypercholesterolemia or diabetes. VLCD followed by dF has been shown to be effective. A double-blind trial randomized 45 patients who had successfully completed 8 wk of treatment on the Cambridge diet to either placebo or dF 15 mg twice daily for 26 wk. Patients continued on a diet giving 60-75% of daily energy needs.(ABSTRACT TRUNCATED AT 250 WORDS)