Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women

Subak, Leslee L. M.D.
Wing, Rena Ph.D.
West, Delia Smith Ph.D.
Franklin, Frank M.D., Ph.D.
Vittinghoff, Eric Ph.D.
Creasman, Jennifer M. M.S.P.H.
Richter, Holly E. Ph.D., M.D.
Myers, Deborah M.D.
Burgio, Kathryn L. Ph.D.
Gorin, Amy A. Ph.D.
Macer, Judith B.Sc.
Kusek, John W. Ph.D.
Grady, Deborah M.D., M.P.H.

From the University of California, San Francisco, San Francisco (L.L.S., E.V., J.M.C., J.M., D.G.); Miriam Hospital, Providence, RI (R.W.); the Warren Alpert Medical School at Brown University, Providence, RI (R.W., D.M.); the University of Arkansas for Medical Sciences, College of Public Health, Little Rock (D.S.W.); the University of Alabama at Birmingham, Birmingham (F.F., H.E.R., K.L.B.); the Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Birmingham, AL (K.L.B.); the University of Connecticut, Storrs (A.A.G.); the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); and the San Francisco Veterans Affairs Medical Center, San Francisco (D.G.). Address reprint requests to Dr. Subak at the UCSF Women's Health Clinical Research Center, 1635 Divisadero St., Suite 600, San Francisco, CA 94115, or at [email protected].
*The investigators of the Program to Reduce Incontinence by Diet and Exercise (PRIDE) are listed in the Appendix.

Supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (U01 DK067860, U01 DK067861, and U01 DK067862) and from the Office of Research on Women's Health.

Dr. Subak reports serving on an advisory board for Pfizer and receiving grant support from Pfizer; Dr. Grady, receiving grant support from Bionovo; Dr. Kusek, owning stock in Eli Lilly, Pfizer, and deCODE Genetics; and Dr. Burgio, serving on an advisory board for Pfizer, receiving grant support from Pfizer, and receiving advisory-board fees from Astellas and GlaxoSmithKline. No other potential conflict of interest relevant to this article was reported.

The views expressed are those of the authors and do not necessarily represent the official views of the NIDDK or the National Institutes of Health.

New England Journal of Medicine 360(5):p 481-490, January 29, 2009. | DOI: 10.1056/NEJMoa0806375

Background

Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking.

Methods

We randomly assigned 338 overweight and obese women with at least 10 urinary-incontinence episodes per week to an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (226 patients) or to a structured education program (112 patients).

Results

The mean (±SD) age of the participants was 53±11 years. The body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) and the weekly number of incontinence episodes as recorded in a 7-day diary of voiding were similar in the intervention group and the control group at baseline (BMI, 36±6 and 36±5, respectively; incontinence episodes, 24±18 and 24±16, respectively). The women in the intervention group had a mean weight loss of 8.0% (7.8 kg), as compared with 1.6% (1.5 kg) in the control group (P<0.001). After 6 months, the mean weekly number of incontinence episodes decreased by 47% in the intervention group, as compared with 28% in the control group (P=0.01). As compared with the control group, the intervention group had a greater decrease in the frequency of stress-incontinence episodes (P=0.02), but not of urge-incontinence episodes (P=0.14). A higher proportion of the intervention group than of the control group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P<0.001), stress-incontinence episodes (P=0.009), and urge-incontinence episodes (P=0.04).

Conclusions

A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction. (ClinicalTrials.gov number, NCT00091988.)