Commercial weight loss program can beat DIY approach

A widely available commercial weight management program led to greater weight reduction than an unstructured do-it-yourself (DIY) approach, according to new data recently published in Open JAMA Network.

In a randomized clinical trial involving nearly 400 adults from Canada, the United States and the United Kingdom, participants who were assigned to WW, formerly known as Weight Watchers, lost twice as much weight as those who tried to lose weight by themselves The WW group also had a greater reduction in weight circumference and was more likely to achieve a 5% weight loss.



Dr. Lesley Lutes

“Research shows that most diets do not result in weight loss that can be sustained over time because they are simplistic, one-size-fits-all approaches to promoting initial weight loss,” study author Lesley Lutes , PhD, MSc, said a professor of psychology and director of the Center for Obesity and Wellness Research Excellence at the University of British Columbia, Kelowna, Canada. Medscape Medical News.

“Unfortunately, because of quick and restrictive recommendations and treating obesity simply as an ‘eat less and exercise more’ approach, people are setting themselves up for long-term failure,” he said. “As a result, they miss out on the critical health benefits, such as a reduced risk of diabetes and heart disease, that can come from even a modest (3% to 5%) weight loss that is maintains over time.”

“A real test”

Given the high global prevalence of obesity, people need accessible and effective treatment options to manage their weight and multiple comorbid conditions, the study authors wrote. Guidelines from professional medical societies recommend behavioral treatment as part of these programs to guide participants, and although clinic-based programs appear to be effective, they are often limited in scope due to time constraints, training and economic

Commercial weight management programs may offer an effective solution, given their greater accessibility and lower costs, the study authors wrote, but few have been rigorously evaluated. The research team chose to investigate WW because it meets the US Preventive Services Task Force criteria for behavioral treatment and has shown evidence of helping participants achieve moderate and sustained weight loss safely .

Researchers conducted a one-year, parallel-group, randomized clinical trial from June 2018 to November 2019 at the University of North Carolina at Chapel Hill in the United States, Columbia University Britannica in Kelowna in Canada and the University of Leeds in the United Kingdom. They focused primarily on weight change at 3 months and 12 months for 373 participants (272 women), as well as health outcomes and quality of life measures.

Study participants had a BMI ranging from 25 to 45 (mean BMI, 33.8). About 38% of participants were between 53 and 75 years old, 22% were between 44 and 52 years old, 20% were between 35 and 43 years old, and 21% were between 18 and 34 years old. About 28% were from underrepresented racial and ethnic groups.

Participants were randomly assigned to either a commercial weight loss program or a do-it-yourself weight loss program. In the DIY group, participants received information about common weight loss approaches available to the public, including diet tracking and self-monitoring apps, meal plans, and physical activity recommendations. These participants were left to work on their own.

In the commercial program, participants enrolled in WW for free and were encouraged to attend weekly workshops, which included a private weight assessment and discussions about successes, problem-solving challenges, and topics related to weight loss and behavior change. They also had access to the WW app for food intake, physical activity, online chats with coaches, and an online peer community.

Notably, the WW program now includes simplified requirements for dietary self-monitoring, meaning you don’t need to track more than 200 foods to weigh and measure them. Instead, the program automatically assigns point values ​​for certain foods and aims for a partial record of food intake, which is designed to reduce the burden of self-monitoring.

Although WW funded the study, Lutes said, the research team insisted that the company not participate with the data and said they would present the results regardless of whether the program worked. In addition, WW sites in the US and Canada were unaware of who their typical customers were compared to study enrollees, and after randomization of participants, study staff were changed to remain blinded to the treatment condition.

“This was a real test of the program, in the real world, with no interaction or influence,” Lutes said. “This allowed us to draw conclusions with clarity, confidence and authority based on the results.”

Analyzes in progress

At the end of the study, retention rates were 89% for the WW group and 96% for the DIY group.

At 3 months, participants in the commercial program had an average weight loss of 3.8 kg (about 8 pounds), compared to 1.8 kg (4 pounds) in the DIY group.

At 12 months, those in the commercial program had an average weight loss of 4.4 kg (almost 10 pounds), compared with 1.7 kg (about 4 pounds) in the DIY group.

Overall, 40.7% of participants in the commercial program achieved a weight loss of 5% of their body weight at 3 months, compared to 18.6% of those in the DIY group. At 12 months, 42.8% of those in the commercial group achieved a 5% weight loss, compared to 24.7% of the DIY group.

Lutes and colleagues are now analyzing additional results from the trial, including treatment uptake and any differences between individuals or groups by treatment format, modality and elements. Lutes is also interested in understanding the interaction between mental and physical health.

“Most people in previous weight loss studies have been screened for depression, anxiety, or another serious mental health condition because it was determined that they probably wouldn’t do as well in treatment. We didn’t do that in this study,” he said. said “I hope we can make some clear recommendations about the potential benefits of treatment, regardless of mental health barriers or challenges.”

“An encouraging finding”

“Although this study is funded by the commercial weight-loss company and may be at risk…the weight-loss results are encouraging and not surprising,” Bradley Johnston, PhD, associate professor of nutrition at Texas A&M University and adjunct professor. at McMaster University, he said Medscape Medical News.



Dr. Bradley Johnston

Johnston, who was not involved in this study, is also the director and co-founder of NutriRECS, an independent group of international experts in medicine, nutrition and public health. In 2020, he and his colleagues conducted a review of randomized trials of 14 popular diet programs and found that many programs result in short-term weight loss and better health outcomes. But at 12 months, these results largely disappear.

“While most randomized controlled trials evaluating interventions for weight loss programs experience regression to the mean (dieters begin to regain their early weight loss), participants in this commercial program lost more weight at 12 months than at 3 months, an encouraging finding,” he said. said

Johnston also expressed optimism about this trial incorporating participant-reported measures of well-being, including happiness, sleep quality and overall health-related quality of life. Although the only statistically significant change was in self-esteem-specific quality of life, he noted, the average change in these measures could be important to the public, even if the numbers are not statistically significant.

“In any case, the authors should be applauded for measuring the outcomes that matter most to the average person looking to improve their health and outlook while losing weight,” he said. “My personal opinion is that all future clinical trials should measure quality of life items such as esteem, anxiety, sleep quality and dietary satisfaction, and government funding agencies should avoid funding trials of weight loss that neglect to measure these essential outcomes for clinical decision-making.”

The study was funded by WW International. Several authors reported receiving grants from WW during the study, and three authors were employees or shareholders of WW during the study. The full list of disclosures can be found with the original article. Johnston reported no relevant financial relationships.

JAMA Netw Open. Published online August 16, 2022. Full text

Carolyn Crist is a medical and health journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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