Combination of group therapy and drug seems most effective.
* THE QUESTION Shedding pounds usually involves more than just cutting calories. Some people also change their behavior -- shopping only from a list, perhaps, or recording what they eat. Others use weight-loss drugs to suppress their appetite. Some do both. What works best?
* THIS STUDY randomly assigned 224 obese adults to follow one of four weight-loss strategies: taking the appetite suppressant sibutramine (Meridia) daily; participating in group therapy aimed at changing lifestyle or behavior; taking the drug and participating in group therapy; or taking the drug and getting brief individual counseling on lifestyle modification. All groups were to eat a balanced diet of 1,200 to 1,500 calories a day and to walk 30 minutes daily. After a year, those who combined the appetite suppressant and the group therapy sessions had lost an average of 27 pounds, compared with average losses of 11 pounds for those who just took the drug, 15 pounds for group therapy only and 17 pounds for the drug coupled with individual counseling. Among people in the combination group, those who regularly kept track of what they ate lost more than twice as much as those who kept only occasional records (40 pounds vs. 17 pounds).
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone seriously overweight and trying to lose. An estimated 64 percent of American adults are overweight.
* CAVEATS The drug used in the study was provided by Abbott Laboratories; three of the 10 authors had received consultant's fees from the pharmaceutical company.
* FIND THIS STUDY Nov. 17 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
* LEARN MORE ABOUT losing weight at http://win.niddk.nih.gov and http://familydoctor.org.
seasonal affective disorder
An antidepressant may help avert wintertime woes.
* THE QUESTION People who feel fine in the spring and summer but become increasingly depressed as winter sets in often turn to light therapy for relief. Might they prevent this seasonal decline altogether by starting to use an antidepressant in the fall, before their mood changes?
* THIS STUDY randomly assigned 1,042 adults with seasonal affective disorder, who had experienced bouts of seasonal depression for an average of 13 years, to take the antidepressant buproprion (Wellbutrin XL) or a placebo daily from early fall until spring. Participants were told not to use light therapy or to travel to a sunny destination for more than five to seven days. That winter, 84 people taking the drug had symptoms of the disorder, compared with 142 of those taking the placebo (16 percent vs. 28 percent). Side effects, including dry mouth, nausea and increased heart rate and blood pressure, were greater among those taking the antidepressant. People taking the drug lost about two pounds, whereas those in the placebo group gained two pounds.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone who has experienced seasonal affective disorder. Among study participants, who were mostly women, nearly 60 percent had never been treated for the disorder.
* CAVEATS Although all participants had had the disorder previously, 72 percent of those in the placebo group did not have episodes of seasonal depression during the study; this high percentage may have been caused by the increased personal attention everyone in the study received. The study was funded by GlaxoSmithKline, which makes Wellbutrin XL, and eight of the nine authors were its employees; the other author had received consultant's fees from the company.
* FIND THIS STUDY Oct. 15 issue of Biological Psychiatry; abstract available online at www.journals.elsevierhealth.com/periodicals/bps.
* LEARN MORE ABOUT seasonal affective disorder at www.nami.org and www.clevelandclinic.org/health.
Compared with other options, traction does not fare well.
* THE QUESTION For centuries, practitioners seeking to treat back pain have used weights and pulleys to stretch the back, aiming to pull the muscles and skeleton into better alignment. But in an era of ultrasound, analgesics and spinal surgery, should traction still be considered a viable option?
* THIS STUDY reviewed the findings of 24 studies, involving 2,177 adults with low-back pain who had been randomly assigned to be treated with traction or something else (a placebo or fake treatment, or other treatments such as physical therapy, hot packs or spinal manipulation). Types of traction included continual and intermittent, mechanical, manual and underwater, among others. Treatments lasted from a week to a year. Based on standardized scales measuring pain and functional ability, people who had received traction fared no better than the others.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with low-back pain, one of the most common reasons Americans visit a doctor.
* CAVEATS The study did not involve original research. Many of the studies reviewed included a small number of participants. Two of the five authors had co-authored two studies that were reviewed; they did not participate in analysis of those studies.
* FIND THIS STUDY Issue 4 of the Cochrane Library; abstract available online at www.cochrane.org (search for "traction").
* LEARN MORE ABOUT treating back pain at www.niams.nih.gov and www.apta.org (search for "back").
-- Linda Searing
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.