The administration of ephedrine and caffeine (E+C) has been proposed to promote weight loss by increasing energy expenditure and decreasing food intake. We tested this hypothesis in six lean (4-9% body fat) and six mildly to moderately obese (13-44% body fat) monkeys studied during a 7-wk control period, an 8-wk drug treatment period, and a 7-wk placebo period. During the drug treatment period, the monkeys were given ephedrine (6 mg) and caffeine (50 mg) orally three times per day. At the end of each period, a glucose tolerance test was performed, energy expenditure was measured, and body composition was determined. Treatment with E+C resulted in a decrease in body weight in the obese animals (P = 0.06). This loss in weight was primarily the result of a 19% reduction in body fat. Drug treatment also resulted in a decrease in body fat in the lean group (P = 0.05). Food intake was reduced by E+C only in the obese group (P < 0.05). Nighttime energy expenditure was increased by 21% (P < 0.03) in the obese group and 24% (P < 0.01) in the lean group with E+C treatment. Twenty-four-hour energy expenditure was higher in both groups during drug treatment. E+C did not produce systematic changes in glucoregulatory variables, whereas plasma leptin concentrations decreased in both groups with drug treatment. Overall, these results show that E+C treatment can promote weight loss through an increase in energy expenditure, or in some individuals, a combination of an increase in energy expenditure and a decrease in food intake.