Women in a weight loss program had a 47% decrease in urinary incontinence episodes at six months.

PARIS—Data suggest that losing even a modest amount of weight using a simple behavioral intervention is an effective, short-term treatment for urinary incontinence (UI) in overweight or obese women.

The data, presented here at the Fourth International Consultation on Incontinence, showed that a behavioral intervention producing a weight loss of 5%-10% of the patient’s baseline weight reduced UI frequency by 47% through six months of follow-up.

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Leslee Subak, MD, associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, and her colleagues randomized 338 women in a 2:1 ratio to a six-month weight loss program or to a structured education program (which served as the control arm).

The study included women aged 30 years or older with a BMI of 25-50 kg/m2 who reported at least 10 UI episodes on a seven-day voiding diary.

Obesity is a strong risk factor for UI, with each five-unit increase in BMI associated with a 60%-100% increased risk of daily incontinence, Dr. Subak pointed out. Among older women with incontinence, 65%-75% are overweight (BMI 26-29 kg/m2) or obese (BMI of 30 or higher).

Preliminary studies of the effect of weight reduction on UI have been encouraging, she added. Researchers have shown, for example, that women with UI randomized to a three-month very-low-calorie-diet had a significantly larger decrease in weekly UI episodes than a control group of women who had no intervention.

All subjects in the present trial were given a self-help behavioral treatment booklet that provided instructions for improving bladder control. The control group participated in four one-hour group education sessions that followed a structured protocol and covered general information about weight loss, physical activity, and healthy eating habits. Incontinence was not discussed.

Women in the weight loss arm met weekly for six months in groups of 10-15 for one-hour sessions led by experts. They were instructed to follow a standard reduced-calorie diet (1,200-1,500 kcal per day) and encouraged to increase physical activity to at least 200 minutes per week.

At baseline, the weight loss and control groups were similar with respect to age, BMI, total number of weekly UI episodes, and UI type (stress/stress predominant in 22%, urge/urge predominant in 44%, and mixed in 34%).

At six months, women assigned to the weight loss intervention had a mean weight loss of 8% (7.8 kg) compared with 1.6% (1.5 kg) in controls. Women in the weight loss group had a mean 47% decrease in total weekly UI episodes compared with 28% in the control group. The reduction in total UI episodes in the intervention group was primarily due to a decrease in stress UI episodes (a 58% decrease in the intervention group vs. 33% decrease in the control arm).

More women in the weight loss group achieved a clinically important reduction of 70% or more in weekly UI episodes than in the control group. There was no difference between the two groups in the use of, or compliance with, techniques presented in the UI self-help behavioral treatment booklet.

Women in the weight loss group perceived a larger improvement in UI and were more satisfied with the change in UI at six months.

“Because a weight loss of 5%-10% has been shown to produce a cascade of other health benefits, it should be considered as a first-line therapy for UI,” Dr. Subak said.