Developing a cost-effective treatment program for the management of obesity using Dexamphetamine

Abstract

The public health problem of obesity is outlined, noting that it is a multifactorial, chronic disease that is increasing in prevalence both globally and in Australia. This underlies the rationale for re-evaluating the currently available treatments, with a view to establishing which might be the most cost-effective.

The historical treatment strategies for obesity are reviewed, compared and scored in terms of efficacy, cost and availability, together with any particular shortcomings that might prevent their widespread adoption. These treatments include lifestyle modification, pharmacotherapies and surgical intervention. Dexamphetamine is identified as having the potential to be a low cost and effective treatment but has been discarded due to concerns about addictive properties. This was investigated further with a narrative review that proved inconclusive.

Given the poor quality of the current evidence, we looked for clinical evidence on the prevalence of dexamphetamine addiction from admissions records in an outer metropolitan drug and alcohol service. Our negative findings are reported.

The final section of the thesis evaluates the feasibility of a six month treatment program using dexamphetamine together with diet and lifestyle for treating obesity. Results from the primary care component from the study are provided. Feasibility outcomes evaluated include: acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited-efficacy testing.

The findings of this thesis could inform a larger trial in primary care. In the longer term, this simple and inexpensive treatment program may have the potential to be used more widely for treating overweight and obesity, particularly in less affluent communities.