A widely available commercial weight management program has resulted in greater weight reductions than a non-regulated do-it-yourself (DIY) approach, according to new data. recently published in JAMA Network is open.
In a randomized clinical trial involving nearly 400 adults from Canada, the United States, and the United Kingdom, participants assigned to WW, formerly known as Weight Watchers, lost twice as much weight as those trying to lose weight on their own. The WW group also had a greater reduction in weight circumference and was more likely to achieve a 5% weight loss.
“Research shows that the majority of diets do not lead to weight loss that can be maintained over time because they are a simplified, one-size-fits-all approach to promoting initial weight loss,” study author Leslie Lotts, PhD, MSc Professor of Psychology and Director of the Center for obesity and Research Excellence Distinguished at the University of British Columbia, Kelowna, Canada Medscape Medical News.
“Unfortunately, because of quick fixes and restrictive recommendations, and treating obesity as just an ‘eat less and exercise more’ approach, people are predisposed to failure in the long run,” she said. “As a result, they do not get the significant health benefits, such as reduced risk of diabetes and heart disease, which can come from modest weight loss (3% to 5%) that is maintained over time.”
The study authors wrote that due to the high prevalence of obesity worldwide, people need accessible and effective treatment options to control their weight and multiple conditions. Guidelines from professional medical societies recommend behavioral therapy as part of these programs to guide participants, and although clinic-based programs appear to be effective, they often have limited scope due to time, training, and financial constraints.
The study authors wrote that commercial weight management programs may offer an effective solution, due to their greater accessibility and lower costs, but few have been rigorously evaluated. The research team chose to investigate WW because it meets US Preventive Services Task Force criteria for behavioral therapy and has shown evidence of helping participants safely achieve modest and sustainable weight loss.
The researchers conducted a one-year, randomized, parallel-clinical trial from June 2018 to November 2019 at the University of North Carolina at Chapel Hill in the United States, the University of British Columbia in Kelowna in Canada, and the University of Leeds in the United Kingdom. They primarily focused on weight change at 3 and 12 months for 373 participants (272 women), as well as health outcomes and quality of life measures.
Study participants’ BMI ranged from 25-45 (mean BMI, 33.8). About 38% of the participants were aged 53-75 years, 22% were 44-52 years old, 20% were 35-43 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 a commercial weight loss program or a DIY weight loss program. In the DIY group, participants received information about popular publicly available weight-loss methods, 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, WW participants were enrolled free of charge and encouraged to attend weekly workshops, which included a special weight assessment, discussions on successes, problem-solving challenges, and topics related to weight loss and behavior change. They also had access to the WW app for dining, physical activity, and online conversations with coaches and an online peer community.
Notably, the WW program now includes simplified requirements for diet self-monitoring, meaning that more than 200 foods do not need to be tracked through their weight and measurement. Instead, the software automatically assigns point values to specific foods and aims to partially log food intake, which is designed to reduce the burden of self-monitoring.
Although WW funded the study, Lotus said, the research team insisted the company not share the data and said they would present the results, regardless of whether the software works. In addition, WW sites in the United States and Canada were unaware of who their typical clients were versus those enrolled in the study, and after randomizing participants, the study staff was changed so that they were blinded to treatment status.
“This was a real test of the program, in the real world, with no interaction or impact,” Lotus said. “This allowed us to draw with clarity, confidence and authority to conclusions based on the results.”
By 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 averaged 3.8 kg (about 8 lb), compared to 1.8 kg (4 lb) in the DIY group.
At 12 months of age, people in the commercial program averaged 4.4 kg (approximately 10 lbs), compared to 1.7 kg (about 4 lbs), in the DIY group.
Overall, 40.7% of participants in the commercial program achieved a weight loss of 5% of their body weight within 3 months, compared to 18.6% in the DIY group. At 12 months, 42.8% of the trade group achieved a 5% weight loss, compared to 24.7% in the DIY group.
Lotus and colleagues are now analyzing additional findings from the trial, including uptake of treatment and any differences between people or groups based on form, method, and treatment items. Lotus is also interested in understanding the interaction between mental and physical health.
“Most people in weight loss studies have been previously checked if they have either depressionor anxiety or any other serious mental health condition because they are likely determined not to perform well in treatment. She said we did not do that in this study. And I hope we’ll be able to make some clear recommendations about the potential benefits of treatment, regardless of mental health barriers or challenges.
“While this study is funded by a commercial weight-loss company and may be at risk of bias…weight-loss results are encouraging rather than surprising,” Bradley Johnston, PhD, assistant professor of nutrition at Texas A&M University and adjunct faculty at McMaster University , He said Medscape Medical News.
Johnston, who was not involved in this study, is also the director and co-founder of NutriRECS, an independent group of international public health and nutrition experts and clinic. In 2020, he and colleagues conducted a randomized trial review of 14 popular diet programs and found that many lead to short-term weight loss and better health outcomes. But by 12 months of age, these results largely disappear.
“While most randomized controlled trials evaluating interventions for weight loss programs have regression to average (dieters begin to regain weight early), participants in this commercial program lost more weight at 12 months than at 3 months, which is an encouraging result. ,” He said.
Johnston also expressed optimism about this trial incorporating wellness measures reported by participants, including happiness, sleep quality and general health-related quality of life. Although the only change that was statistically significant was quality of life for self-esteem, he noted that the average change across these scales could be significant for the audience, even if the numbers were not statistically significant.
“Regardless, the authors should be commended for measuring outcomes that are most important to the average person looking to improve their health and outlook with weight loss,” he said. “My personal view is that all future clinical trials should measure quality-of-life components such as discretion, anxiety, sleep quality and satisfaction with diet, and government funding agencies should avoid funding weight-loss trials 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 contributors to WW during the study. The full list of disclosures can be found with the original article. Johnston reported no relevant financial relationships.
Gamma neto is open. Posted online August 16, 2022. full text
Caroline Krist is a health and medical journalist reporting on the latest studies for Medscape, MDedge, and WebMD.
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