Sibutramine is a tertiary amine originally developed as a potential antidepressant, but with weight-loss-inducing properties. These properties are induced by a dual mechanism involving the inhibition of neuronal reuptake of norepinephrine and serotonin at the receptor sites that affect food intake, and the prevention of the decline in energy expenditure during weight loss.4 This drug induces dose-dependent weight loss5 and, over a year's treatment, can amplify the effects of a very low calorie diet.6 We assessed sibutramine's ability to maintain longer-term weight loss by doing a randomised, placebo-controlled, double-blind, parallel-group trial with an open run-in. During the first (open) 6 months, patients underwent a managed weight-reduction phase incorporating sibutramine. Patients in whom appreciable weight loss were achieved went on to the randomised phase, which was designed to assess sibutramine's ability to maintain, over the subsequent 18 months, the weight loss achieved in the open phase.