The next time a patient asks which weight-loss programs work best to shed pounds and keep the weight off, a physician now might recommend Weight Watchers or Jenny Craig, thanks to evidence from a recent study.
The study(annals.org), published online April 7 in Annals of Internal Medicine, examined 11 commercial weight-loss programs and found that only Weight Watchers and Jenny Craig showed evidence of effective long-term weight loss.
Researchers reviewed 45 studies, 39 of which were randomized controlled trials (RCTs) of at least 12 weeks' duration to compare weight loss, adherence and harms of commercial or proprietary weight-loss programs compared with control/education (defined as no intervention, printed materials only or fewer than three consultations with a health care professional) or behavioral counseling (defined as three or more such consultations). Prospective case series and RCTs that lacked a relevant comparator group but were of 12 months' duration or longer also were assessed for harms only.
Of the 11 weight-loss programs with eligible RCTs that researchers reviewed, all emphasized nutrition and behavioral counseling or social support components with or without physical activity. Those programs were Weight Watchers, Jenny Craig, Nutrisystem, Health Management Resources, Medifast, OPTIFAST, Atkins, The Biggest Loser Club, eDiets, Lose It! and SlimFast.
- A study published online April 7 in Annals of Internal Medicine reviewed 11 commercial weight-loss programs and found that only Weight Watchers and Jenny Craig were effective for long-term weight loss.
- Researchers reviewed 45 studies to compare weight loss, adherence and harms of the commercial or proprietary weight loss programs.
- At 12 months, Weight Watchers participants achieved at least 2.6 percent greater weight loss than the control group, and Jenny Craig users saw at least 4.9 percent greater weight loss than the control group.
Only Jenny Craig and Weight Watchers showed evidence of helping people lose weight and keep it off for 12 months or longer, said the authors.
At 12 months, Weight Watchers participants achieved at least 2.6 percent greater weight loss than the control group, and Jenny Craig users saw at least 4.9 percent greater weight loss than the control group.
Other programs, including NutriSystem, showed comparable weight-loss results in the short term, but the study said additional research is needed to determine their long-term results.
FP Expert's Thoughts
Jason Matuszak, M.D., of Buffalo, N.Y., a sports medicine specialist and member of the AAFP Commission on Health of the Public and Science, told AAFP News he thinks the biggest problem physicians face when working with overweight/obese patients is addressing the issue head-on.
"Many physicians are afraid of injuring a patient's sensitivities or offending them," he said. "The physicians that do bring up weight loss to their patients are often seen as rude or insensitive.
"As physicians and as patients, we need to understand the conversation is not about being 'fat,' but rather trying to make people the healthiest version of themselves they can be. Genetics do play a big role, but learned behaviors probably play just as big a part."
A big limitation of the current Annals study, according to Matuszak, is that it involved a high percentage of female participants and was prone to self-selection bias.
“A main reason people fail on diets is they still inherently believe when they are on a diet, they are making some type of temporary sacrifice.”
— Jason Matuszak, M.D.
"It is not clear that men would attain the same benefit," he said. "Also, because people often self-select for programs that may fit their personality, the outcomes may be accentuated and not reflective of what would happen with your 'average' patient."
Still, Matuszak acknowledged weight-loss programs can be useful for many of these patients.
"My (patients') experiences have been generally good with Weight Watchers, and less so from most of the other programs," he said. "The best benefit comes when I see patients actively engaged with the programs, including attending meetings. In some ways, it mirrors some of the same support that we know works for Alcoholics Anonymous and other addiction programs."
Even so, said Matuszak, most commercial diets shouldn't really be considered diets because they just educate people to eat what are, after all, normal amounts of food with average numbers of calories.
"A main reason people fail on diets is they still inherently believe when they are on a diet, they are making some type of temporary sacrifice, and when they want to reward themselves or relax because they've reached their goal, they return to their previous pattern of eating," he said.
Matuszak thinks any diet plan can be successful as long as the patient and the program "click."
"With that in mind, some people like the group visits with Weight Watchers, while others prefer doing their own thing with Atkins," he said. "People who need less education tend to do better with individually guided programs and people who need more encouragement and education tend to do better with group programs that feature a lot of education."
Matuszak said one of the downsides of weight-loss programs is the associated cost, which can be restrictive. Some people also have trouble transitioning from these programs into lifelong changes, he added. "These people feel dependent on getting the meals or meal replacements, essentially, forever," said Matuszak.
"I always try to find a program that fits a particular person's lifestyle and personality," he said. "There also is an element of finances that has to be considered. Weight Watchers is among other programs that do not require someone to purchase specialty meals or meal replacements, which can be good because they tend to be lower-cost."
Cognitive-behavioral interventions with patients trying to lose weight also are effective, although these programs are harder to find, Matuszak said. "The advantage to the commercial systems is that they are pretty much 'plug and play,"' he said. "Any patient can find these programs in most regions -- even in many rural areas."
Overall, Matuszak thinks addressing the obesity epidemic in the United States will be the single most important issue facing medicine moving forward.
"We need to separate the self-image and love-of-self issues from the medical ones and have an honest conversation about being at a healthier weight," he said.
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