Commercial weight loss programs may offer advantages

Clinicians could consider referring overweight or obese patients to commercial weight loss programs, although some programs will require more study to confirm long-term effects, a review found.

To compare the effects of commercial weight loss programs with control groups of no or few interventions or behavioral counseling among overweight and obese adults, researchers conducted a review of 45 studies (39 randomized, controlled trials) of at least 12 weeks' duration or prospective case series of at least 12 months' duration (harms only). The review adds studies that have appeared in the peer-reviewed literature since a previous review was conducted in 2005. It was published in the April 7 Annals of Internal Medicine.

At 12 months, participants in Weight Watchers achieved at least 2.6% greater weight loss than those assigned to control/education, and Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. At 3 months, Nutrisystem resulted in at least 3.8% greater weight loss than control/education and counseling. Very-low-calorie programs such as Health Management Resources, Medifast, and OPTIFAST resulted in at least 4% greater short-term weight loss than counseling, but researchers found some attenuation of effect beyond 6 months, when such data were reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed.

The researchers noted that Affordable Care Act (ACA) coverage may increasingly prompt clinicians to consider referring patients to commercial programs. A recent weight management guideline from medical societies recommends that clinicians refer overweight and obese patients to high-intensity programs but doesn't address commercial weight-loss programs.

“Because the ACA is likely to increase obesity screening, having an actionable plan that addresses weight management is critical,” the authors wrote. “Health insurers and employers may want to consider providing benefits coverage or incentives of reduced program fees to beneficiaries and employees for commercial programs with strong evidence of effectiveness. On the basis of our findings, we would identify Weight Watchers and Jenny Craig for consideration for such benefits coverage.”

An accompanying editorial noted that study data often do not reflect what actually happens in real life. Clinical trials test a single intervention in an optimal context, and studies also rarely leverage the physician-patient relationship.

“Although earlier studies have suggested limited effectiveness of physician counseling about weight when it is done in isolation, physicians can potentially play an important role,” the editorial noted. “For example, they can encourage adherence to lifestyle changes by making the link between modest weight loss and health benefits and providing behavioral reinforcement in partnership with a structured behavioral program.”