Response

Dr Lexchin and colleagues correctly note that the data on the long-term benefits of antiobesity medications are perhaps not as robust as I made them out to be. There is no doubt that high dropout rates and lack of follow-ups are severe methodologic shortcomings of studies in this field. Nevertheless, from the long-term data available, weight maintenance (especially in per-protocol analyses) in participating individuals appears substantially superior to the nonpharmacologic controls of these studies.1

A seemingly modest 5% to 10% reduction in body weight (achieved in most pharmacologic trials) is generally associated with clinically meaningful improvements in risk factors (of obesity) and quality-of-life indicators.2

The key challenges of pharmacotherapy are how to match the right patient with the right drug and how to ensure long-term compliance and adherence to the medication in order to maximize the benefits. Obesity is a remarkably heterogeneous condition; the expectation that any one drug will work for all patients with obesity is probably unrealistic.

I fully agree with Dr Lexchin and his colleagues that more research is needed to discover the best use of these medications; nonpharmacologic strategies are clearly unsuccessful in providing long-term control of this condition.3

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