This week, lets take a look at a study published in The Obesity Journal  on a real world application of one of the  newer obesity medications (Contrave).  Contrave is a combination drug treatment for obesity. It combines bupropion and naltrexone and was approved by the FDA in 2010.I like this study because it looks at how a medication like Contrave can be used alongside current lifestyle programs.  The study basically took 242 people and gave them all the same internet and phone based lifestyle program(similar to Weight Watchers). Half of the individuals were also placed on Contrave for first 24 weeks. After 6 months, the other half was then given the medication.

Lesson 1: Medications help you lose weight and keep it off

At 6 months, individuals who received medication lost 9.5 times more weight than those who did not (9.5% vs 0.8% weight loss). They were 12 times more likely to reach 10 and 15% weight loss and 4 times more likely to hit 5% more weight loss. People who took the medication averaged about 10% weight loss at 18 months.

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Combing a lifestyle program with weight loss medications makes a huge difference in weight loss at 6 months and 18 months.

Lesson 2: Are you an optimal responder or a non-responder to a medication?

Medications don’t work equally for everyone. Some people respond really well while others may not respond at all.   People who are optimal responders tend to lose at least 7.5% of their weight in the first 3-4 months. People who are non-responders lose 2.5% or less in 4 months.

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Optimal responders lose 7.5% of their weight compared to 2% in non-responders.

The good news is that you can figure this out in 12 weeks and there is no need to continue a weight loss medication beyond that if your not responding to it. Some individuals lost 30% of thier weight while others gained weight doing the same exact thing. Finding a solution to your wieght problem  is not about getting on the best diet, medication, or program but rather all about finding which one works best for you.

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There is large variability in the way people respond to medication plus lifestyle program.

 

Lesson 3:  While medications boost your results, they also increase the chance you may dropout of your program

The medication group was five times more likely to stop their program. This makes sense given the extensive side effect profile of Contrave. Again, this really does emphasize that people will respond differently to the same medication and individual variability is something that should never be ignored by physicians.

Lesson 4: People who waited to take medication did just as well or even a little better

The unique thing about this study is that it shows that it does not hurt to wait to start a weight loss medication. As a mater of fact, individuals who started Contrave at 6 months rather than at the start, lost slightly more weight at 18 months despite losing a lot less weight in the first 6 months. At Enara Health, I often start people off with  lifestyle  and behavioral changes first. I will only add medications at the 6 month mark or if they hit weight loss plateau. By timing medications at the right time, I help people lose more weight (our average is 15-16%) and more importantly maintain it. Lastly, by tracking their behavior with our mobile app we are able to better tell which medications they might respond best to. Combining evidence based approaches in succession and personalizing them is what we need to do if we are going to create sustainble approaches to the obesity epidemic and give people a fighting chance.

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Weight loss was sustained at 18 months and individuals who waited to start the medication lost just as much weight at 18 months.
This article is part of our clinical studies series. Once a week Enara Health takes a deeper look at a clinical study or article. 
Posted by:Dr. Rami Bailony

Dr. Bailony completed his medical school and internal medicine training from UCSF. Thereafter, he went on to complete a fellowship in Healthcare Innovation with Medicine X at Stanford University where he focused on behavioral change, obesity and diabetes management. From there he went on to co-found Enara Health and Enara Health Group which uses online and mobile platforms to provide clinical programs for obesity and type II diabetes.

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