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Effects of caloric restriction and fenfluramine on weight loss and personality profiles of patients with long standing obesity.

Summary: Fifty consecutive patients who were referred to a special clinic for weight reduction were 49% in excess of their ideal body weight and had been obese for an average of 19 years. Sixtyfour percent exhibited a personality disorder on psychological testing and almost all patients had had at least one previous unsuccessful attempt at weight reduction. They had a good understanding of dietetics, but made the dietitian's task difficult by grossly understating their caloric intake. With detailed dietary instruction and regular super-vision there was no improvement in the patients' concepts of nutrition, four patients reduced to an ideal body weight, 24 defaulted after losing an average of 2.9 kg and 22 were given fenfluramine (120 mg/day) when their weights became static after an average loss of 3.4 kg. Addition of fenfluramine to the therapeutic regime for three months caused a significant and progressive loss of weight, but failed to causeanychanges in mood as measured by psychological testing. After a further three months on fenfluramine most patients ceased losing weight despite large increases in the dose. Thus, many patients neither required nor benefitted from the services of a dietitian, they could not be motivated to adhere to a low calorie diet, and those who received fenfluramine eventually became resistant to its anorectic effects.