How physician obesity specialists use drugs to treat obesity

Obesity (Silver Spring). 2009 Sep;17(9):1730-5. doi: 10.1038/oby.2009.69. Epub 2009 Mar 19.


Specialist physicians may have prescribing habits that are different from nonspecialist physicians. Little is known about the prescribing habits of physicians specializing in the treatment of obesity. An anonymous survey was given to the physician members of the American Society of Bariatric Physicians (ASBP). There was a 35% response rate (266 physicians) to the questionnaire that was represented nationally. Almost all prescribed medications and all of them recommended phentermine. The average maximal dose of phentermine was above that approved in the package insert, and these physicians disagreed with the National Institutes of Health (NIH) Obesity Treatment Guidelines. Phendimetrazine, metformin, and phentermine plus L-5-hydroxytryptophan (5-HTP) with carbidopa were all used more frequently than either orlistat or sibutramine. The combination of sibutramine and orlistat as well as 5-HTP/carbidopa were prescribed by 14 and 20%, respectively. As 5-HTP-carbidopa was a combination not previously reported for the treatment of obesity, a retrospective chart review was performed in a single obesity practice, which may not be representative. Twenty-two subjects had a 16% weight loss with phentermine over 6 months and an additional 1% weight loss with the addition of 5-HTP/carbidopa for an additional 6 months. One subject who started on 5-HTP/carbidopa alone lost 24.4% of initial body weight over 6 months. This questionnaire revealed that 20% of the obesity specialists responding to the survey used phentermine plus of 5-HTP/carbidopa, an unreported combination. A controlled, randomized, clinical trial to evaluate the safety and efficacy of this combination in treating obesity should be considered.

MeSH terms

  • 5-Hydroxytryptophan / therapeutic use
  • Anti-Obesity Agents / therapeutic use*
  • Carbidopa / therapeutic use
  • Drug Combinations
  • Drug Labeling
  • Drug Therapy, Combination
  • Drug Utilization
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Medicine* / statistics & numerical data
  • Obesity / drug therapy*
  • Phentermine / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Prescription Drugs / therapeutic use*
  • Retrospective Studies
  • Specialization*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • United States
  • Weight Loss / drug effects


  • Anti-Obesity Agents
  • Drug Combinations
  • Prescription Drugs
  • Phentermine
  • 5-Hydroxytryptophan
  • Carbidopa