Leslee L. Subak, MD, of the University of California, San Francisco, and colleagues, reported in a January issue of the New England Journal of Medicine that weight loss may significantly improve urinary incontinence for overweight and obese women. A loss of about 17 pounds in an extensive six-moth diet and exercise program reduced the average number of weekly incontinence episodes by 47% compared with 28% for the control group.
Losing weight was particularly effective against stress incontinence in the randomized trial, and was as effective overall as behavioral treatments, such as pelvic muscle exercises. Dr. Subak reports that these findings may help motivate incontinent patients to overcome the common fear of episodes occurring during exercise. The researchers’ Program to Reduce Incontinence by Diet and Exercise (PRIDE) study included 338 overweight and obese women with at least 10 urinary incontinence episodes per week, with an average of 24 episodes per week. Participants were randomized to an intensive six-month weight-loss program of reduced-calorie diet, exercise, and behavior modification (226 participants) or to four group classes on the benefits of exercise, a healthy diet, and weight loss (112 participants). By the end of the program, the average weight loss from baseline was 8.0, compared with 1.6% among controls.
More women in the weight-loss group had a clinically relevant reduction of at least 70% in total weekly incontinence episodes, stress-incontinence episodes per week, and urge-incontinence episodes per week. The primary effect of weight loss was on stress incontinence, which dropped by 57.6% compared with 32.7% among controls.
Urge incontinence, which was more common in both groups at baseline, tended to also decrease with weight loss, but the effect was not significant compared with other controls.
Limitations of the study include the fact that it relied on self-reports, the lack of blinding, and the fact that participants were selected by potential for adhering to behavioral modification, which might limit generalizability.