Obesity-news Phen/fen Maintenance Survey Results

The phen/fen maintenance survey was carried on the Obesity-news web site from April through August 1997. Participants completed a 22 question survey. Those who met the criteria, were included in this report.

Purpose and criteria.

The purpose of the survey was to determine the percentage of patients who were able to maintain weight once they discontinued medication and the percentage who were able to maintain weight with a maintenance dose of medication. Patients taking any anorectic medication were included in the results if they 1) discontinued medication for any reason, including goal weight, or 2) reached goal weight and were taking a maintenance dose of medication at the time they submitted the survey.

Participant overview.

Seventy-eight surveys fit the criteria. Participants ranged in age from 18 to 58 years old. Starting weight ranged from 570 lbs to 140 lbs. Fifty-eight of the 78 performed some kind of regular exercise and 20 did not. Sixty-five respondents were female, 13 male. Most respondents took phen/fen, but some took phentermine alone (5), dexfenfluramine (2), phen/dexfen (3), phendimetrazine (2), and tenuate (1).

Thirty-one participants reached goal. Out of the 31 who reached goal 18 were able to maintain their weight, but only three reported being able to do so without medication. Thirteen respondents reached goal but did not maintain. Six of those went back on medication and 5 were able to maintain their weight. Continuous medication was a higher correlation to weight maintenance than exercise. The longest length of medication was 25 years (on and off), the shortest one week.

Fifty-seven participants did not reach goal. Nine respondents were able to maintain a weight loss of 10-100 lbs with no medication from 1 to 12 weeks. One patient reported continuing to lose weight after stopping the medications. Eight restarted the medications and either maintained or lost more weight. Several more in this group reported that they will start medication again in the near future.

MEDICATIONS USED
Medication	Number	Dose range
Phen/fen	64	High: 60 mg phentermine/60 mg fenfluramine Low: 8 mg phentermine/10 mg fenfluramine
Phen/dexfen	3	High:30 mg phentermine/30 mg dexfenfluramine Low: 24 mg phentermine/15 mg dexfenfluramine
Phen/fen alternating with dexfen	1	30 mg phentermine/60 mg fenfluramine 30 mg dexfenfluramine
Phentermine only	5	High: 37.5 mg Low: 30 mg
Phendimetrazine	2	High: 105 mg Low: 70 mg
Dexfenfluramine	2	30 mg
Tenuate	1	32.5 mg

Participants who reached goal and maintained weight.

No maintenance medication: Two of the three participants who reached goal and maintained their weight with no medication, were able to do so for six months or longer. A 56-year old male had only maintained weight two weeks post medication, and was already suffering with cravings. A 57-year old woman who maintained her weight for 26 weeks began suffering from cravings 4 weeks after discontinuing the medications. A 20-year old woman didn't specify if cravings returned or not, but she exercises 10.5 hours a week in order to maintain weight.

With maintenance medication: By far this group had the most success, with 15 patients maintaining weight for a period ranging from 4 to 75 weeks. The time period reflected for patients who continued with the same dose for maintenance is cumulative for the weight loss and maintenance periods. Only two respondents in this group, both of whom were on a reduced maintenance dose, reported the return of cravings. Exercise did not appear to play a significant role in this group. Four respondents didn't exercise at all, one exercised less than an hour a week, 5 exercised moderately (3-5 hours a week), and 5 exercised strenuously (6-9 hours a week). The length of maintenance did not appear to have any correlation to the amount of exercise or whether the participants exercised.

PARTICIPANTS WHO MAINTAINED WEIGHT WITH NO MEDICATION
Age/Sex	Wks. Maint.	Cravings Returned	Pounds Lost	Weight Loss Period (in weeks)	Years Obese	Exercise (hours per week)
57-F	26	4 weeks	36	unk	10	2
56-M	2	5 days	42	24	30	6
20-F	52+	unk	90	16	7	10.5

PARTICIPANTS WHO MAINTAINED WEIGHT WITH CONTINUING MEDICATION
AGE/SEX	WKS. MAINT.	CRAVINGS RETURNED	POUNDS LOST	WEIGHT LOSS PERIOD (weeks)	YEARS OBESE	EXERCISE (hours per week)	MAINTENANCE DOSE
58-M	26	no	102	40	15	5	pulsed
54-F	4	no	53	52	20	>1	same
54-F	16	no	45	48	20	none	pulsed
51-F	12	yes	24	75	35	none	reduced
46-M	104	no	50	unk	35	none	same
46-M	40	unk	160	unk	30	5	same
45-F	78	no	35	unk	20	3	same
44-F	44	unk	49	64	15	none	reduced
44-F	12	yes	77	40	15	9	reduced
43-M	6	no	75	49	15	8	reduced
43-F	75	no	20	100	10	6	reduced
41-F	24	no	90	52	30	7	30 mg amphetamine
38	20	unk	42	40	20	4	reduced
35	26	no	50	45	12	4	reduced
31	20	yes	35	30	8	5	reduced

Key: phen/fen, phentermine, phen/dexfen, fenfluramine, unk.
amphetamine - this patient was diagnosed with ADD some time either during or after her phen/fen treatment. She takes no phen/fen, but 30 mg of amphetamine for the ADD.

Participants who reached goal but did not maintain weight.

Discontinued medication. The seven respondents in this group gained between 3 and 40 lbs in 4 - 104 weeks. All individuals in this group regained weight regardless of exercise. A 50-year old male who exercised 11 hours per week regained 15 lbs in 20 weeks. A 46-year old female who didn't exercise at all, regained 3 lbs in 4 weeks. Those who lost more didn't gain weight back faster than those who lost less.

Restarted medication after weight gain. Six respondents restarted medication after gaining between 4 and 14 lbs in 5 - 18 weeks. One pulsed medication, two took a reduced dose, one the same dose. Two had to take more medication than their initial dose. A 55-year old woman on a reduced dose was the only one in the group who could not maintain after an initial weight gain.

PARTICIPANTS WHO TOOK NO FURTHER MEDICATION
Age/Sex	Pounds Lost	Length On Medication	Years Obese	Length Off Medication	Pounds Regained	Exercise (hours per week)
51-M	50	40	35	20	15	11
51-F	40	24	13	50	25	5
46-F	30	16	30	4	3	none
45-F	35	20	30	8	3	6
43-F	65	26	20	104	40	7
42-F	85	52	10	unk	10	none
33-F	35	45	25	5	10	6.5

PARTICIPANTS WHO RESTARTED MEDICATION AFTER INITIAL WEIGHT GAIN
Age/Sex	Pounds Lost	Length On Medication	Years Obese	Length Off Medication	Pounds Regained	Exercise (hours per week)	Length New Dose (weeks)	Dose
55-F*	75	42	40	8	4	1.5	unk	reduced
43-F	40	43	30	unk	10	5	6	pulsed
42-F	75	86	32	5	14	6	unk	same
42-F	24	20	25	18	6	7	unk	more
39-F	20	5	30	5	5	3	unk	more
31-F	35	30	15	11	6	none	3	reduced

Key: phen/fen, unk, phendimetrazine.
* was not able to maintain weight with a reduced dose, and gained 4-8 more lbs. All others in this group were able to maintain weight.

Participants who did not reach goal.

Discontinued medication. 42 respondents in this group ranged from 18 to 57 years of age. Thirty-four were women, 7 male. The longest length of therapy was 156 weeks, the shortest one week. Ten in this group were able to maintain their weight loss for a period ranging between one and 12 weeks. A 47-year old woman, 13 lbs from goal was able to maintain the longest at 12 weeks. All respondents reported a return of food cravings after 1 day - 10 weeks without medication.

While there was no long term weight maintenance in this group, this group did better without medication than the group that reached goal. Three patients in this group maintained their weight for 1 - 2 weeks, two for 4 - 5 weeks and three for 9 - 12 weeks. Most respondents lost 50 percent or more of their weight. A 34-year old woman who lost 34 lbs and maintained the loss for 9 weeks, was only 6 lbs from goal. A 41 year old male commented that although his cravings returned right away, he lost another 17 lbs after discontinuing medication and is now 18 lbs from goal. This is the one group where exercise may have been of benefit. Almost all were "moderate" exercisers -- 3 - 6 hours a week. One did minimal exercise, one none and one 12 hours per week.

Restarted medication. Three respondents restarted medication after regaining between 5 and 13 lbs in 4-12 weeks. All went on reduced doses. A 43 year old female was able to maintain her weight for three weeks, and a 42-year old female for four weeks on the reduced dose. A 41-year old woman lost four more pounds in 8 weeks on a reduced dose.

One 37-year old female went on and off the medications for several weeks at a time. She was able to maintain during the weeks off, but said she was going back on the medications to lose her last ten pounds.

PARTICIPANTS WHO TOOK NO FURTHER MEDICATION
Age/Sex	Weeks Maintained Weight	Cravings Returned	Pounds Lost	Pounds From Goal	Exercise (hours per week)
57-M	5	5 days	46	24	3
48-F	10	10 days	42	33	4
47-F	12	2 weeks	47	13	4
44-M	2	1 day	15	unk	4.5
41-F	1	1 day	25	15	none
41-M	4	1 day	8	27	1
34-F	9	6 weeks	34	6	12
27-F	1	2 days	46	54	6

Reasons for discontinuing medication.

This was not a question on the survey, but many patients related reasons why they stopped the medications in the comments section. The major reasons were: doctor's refusal to renew (8), media hype on PPH or heart valve disease (6), family pressure/stress (6) loss of effectiveness (5), side effects (5), pregnancy (2). Of the two women who said they discontinued the medications due to pregnancy, one stopped the medications before getting pregnant, the other woman became pregnant while on the medications. The second woman later had a miscarriage.

Other comments.

Five respondents reported that Redux was ineffective. Six who stopped medication intended to start again. Patients also commented on medication tolerance, reporting less effectiveness while still taking medication and finding phen/fen less effective the second time around.

Although research shows that obesity is mostly determined by genetic factors, many respondents said they felt obesity medications were a "jump start to good habits", or that they should be able to "just do it". Some also expressed fear of becoming dependent on medications. Outside of one man who indicated he had been on and off of phen/fen over the last 25 years, I heard from a woman, who did not fill out a survey, but wrote that she had been taking phentermine for the last 22 years. She has maintained her weight within several pounds of goal during the entire time.

Conclusions.

Respondents on continuous parmacotherapy had the greatest successes. However, in this survey, the respondent on the longest course of continuous therapy (including weight loss and maintenance phases) was 104 weeks. Between 104 and 156 weeks, some of the Weintraub subjects began to gain weight, notwithstanding continuous medication and adherence to dietary restriction and increased exercise. However, Weintraub subjects on medication did maintain weight more successfully than those taking placebo.

Respondents to the survey, on the other hand, may receive individual dosage adjustments which could help in weight maintenance.

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PHEN/FEN MAINTENANCE SURVEY