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Why You Should Outsource Your Weight Loss Treatment
Abstract & Commentary
By Barbara A. Phillips, MD, MSPH, Professor of Medicine, University of Kentucky; Director, Sleep Disorders Center, Samaritan Hospital, Lexington. Dr. Phillips serves on the speakers bureaus for Cephalon, Resmed, and Respironics.
Synopsis: Participation in Weight Watchers resulted in a greater weight loss over a year than did clinical intervention in a primary care office.
Source: Jebb SA, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: A randomised controlled trial. Lancet 2011; doi:10.1016/S0140-6736(11)61344-5.
This study (which was funded by Weight Watchers) was a multicenter, randomized, controlled trial involving patients recruited from primary care practices in Germany, Australia, and the UK. To be included, patients had to have body mass index (BMI) of 27-35 kg/m2 and at least one additional risk factor for obesity-related disease, including central adiposity, type 2 diabetes without insulin treatment, family history of diabetes, previous gestational diabetes, impaired glucose tolerance, dyslipidemia, hypertension, polycystic ovarian syndrome, lower-limb osteoarthritis, or abdominal hernia. People were excluded for a variety of reasons, including having had a weight loss of 5 kg or more in the previous 3 months, eating disorders, limitations to regular physical activity, untreated thyroid disease, ongoing or past surgical treatment for weight or appetite, and insulin-treated diabetes. Participants were randomized to receive 12 months of free access to a Weight Watchers program or 12 months of standard care, as defined by national treatment guidelines in the three participating countries.1-3 A total of 772 people were recruited, screened, and randomized, and were assessed at 2, 4, 6, 9, and 12 months with measurements of weight, fat mass, waist circumference, blood pressure, and biomarkers of cardiovascular risk, as well as self-reported data about food intake and physical activity. The Weight Watchers program was more intensive; participants attending assessment visits for standard care reported a mean of one appointment per month with their health care provider, but those assigned to the Weight Watchers group attended a mean of three meetings per month in the UK and Australia and two meetings per month in Germany.
The dropout rate was high, with only 61% of those in the Weight Watchers group and 54% of those in the "standard care" program completing the full 12 months of assessment. Notably, the patients from Germany were much less likely to drop out; 75% of them completed the study. Participants who completed the 12-month assessment were significantly older at baseline (mean, 50.2 years) than were those who did not (43.6 years), but there were no significant effects of sex, baseline weight, or diabetes status on whether individuals completed the 12-month assessment. Of those who completed the year of follow-up, those in the Weight Watchers group lost about twice as much weight as those in the usual care group: 5.06 kg (11 lbs) vs 2.25 kg (5 lbs). Those in the Weight Watchers program were also more likely to lose at least 5% or 10% of their weight. Participants randomized to the commercial program also had larger reductions in waist circumference, fat mass, insulin, and ratio of total to HDL cholesterol. There were small reductions in blood pressure in both treatment groups. No adverse events were reported by either group.
I found the results of this trial dismal, but not surprising. The most discouraging thing was that only slightly more than half of the people (who were motivated enough to enroll and go through screening) completed the trial. It is probably safe to say that those who didn't finish the study probably didn't lose any weight. Also discouraging is that those who did complete the most effective protocol only lost about 11 pounds on average. Obesity is a chronic, intractable disease. And dealing with it consumes a great deal of time and emotional energy in almost every aspect of medicine. This report confirms and extends other studies of commercial weight loss programs, including Weight Watchers and Jenny Craig, demonstrating that these types of programs are more effective in addressing the intractable problem of obesity than are interventions in clinicians' offices.4-8 As a physician who is confronted daily by the implacably obese, I find this to be powerful, time saving-information. Specific referral to a commercial weight loss program may result not only in greater weight loss for my patients, but also in reduced angst, wasted time, and reprimands by customer service personnel for me.
4. Lavin JH, et al. Feasibility and benefits of implementing a slimming on referral service in primary care using a commercial weight management partner. Public Health 2006;120:872-881.
5. Heshka S, et al. Weight loss with self-help compared with a structured commercial program: A randomized trial. JAMA 2003;289:1792-1798.
6. Rock CL, et al. Randomized trial of a multifaceted commercial weight loss program. Obesity (Silver Spring) 2007;15:939-949.
7. Tsai AG, Wadden TA. Systematic review: An evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005;142:56-66.
8. Rock CL, et al. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: A randomized controlled trial. JAMA 2010;304:1803-1810.