Background Obesity has been identified as a risk factor for
atherosclerosis, and fat distribution has proved to be a critical variable.
Weight loss improves health, but failure rates in dietary treatment are high.
The effects of dexfenfluramine, which is useful in many patients, were studied
on cardiovascular risk factors in obese female patients with upper and lower
body obesity.
Methods In a placebo-controlled, double-blind trial, which was part
of a multicentre study, 52 obese female patients (body mass index 35.1
± 7.8 kg/m2, age 43.3 ± 6.4 years) were given
either 15 mg dexfenfluramine twice daily, or placebo in addition to a
calorie-restricted diet (1500 kcal/day) for 12 months. Forty-two patients (20
with upper body obesity, 12 dexfenfluramine and 10 placebo; 22 with lower body
obesity, 16 dexfenfluramine and six placebo) completed the 14-month study.
Results Patients with upper body obesity lost 14.2 ± 2.20
kg with dexfenfluramine, and 4.92 ± 2.99 kg with placebo
(P ≤ 0.05). In contrast, patients with lower body
obesity lost 11.1 ± 2.89 kg with dexfenfluramine and 2.6 ±
2.32 kg with placebo (P < 0.05). With
dexfenfluramine, patients with upper body obesity lost more weight than patients
with lower body obesity (P < 0.05). After 1 year of
dexfenfluramine treatment, reduction of systolic blood pressure in patients with
upper body obesity (157 ± 10 versus 133 ± 8 mmHg,
P < 0.05) was significantly (P
< 0.05) greater than in patients with lower body obesity (136
± 14 versus 127 ± 12 mmHg).
During dexfenfluramine treatment cardiovascular risk factors improved. In upper
body obesity blood glucose (5.18 ± 0.28 versus 4.40 ± 0.34
mmol/l, P < 0.05), serum insulin (23.4 ±
8.9 versus 13.2 ± 4.2μU/ml, P
< 0.05) and triglycerides (1.96 ± 0.45 versus 1.23
± 0.54 mmol/l, P < 0.05) decreased, and
high-density lipoprotein cholesterol increased (1.0 ± 0.14 versus
1.21 ± 0.14 mmol/l, P < 0.05). In lower
body obesity, cardiovascular risk factors were in the normal range and did not
change significantly during the study.
Conclusions Dexfenfluramine lowers body weight in obese patients
with upper and lower body obesity and reduces the cardiovascular risk factors
clustering in upper body obesity.
