A widely available commercial weight-management program led to greater weight reductions than an unstructured do-it-yourself (DIY) approach, according to new data recently published in Open JAMA Network.
In a randomized clinical trial that included 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 on their own. The WW group also had a greater reduction in weight girth 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 maintained over time because they are simplistic, one-size-fits-all approaches to promoting initial weight loss,” said study author, Lesley Lutes, PhD, MSc, professor of psychology and director of the Center for Obesity and Well-Being Research Excellence at the University of British Columbia, Kelowna, Canada, said Medscape Medical News.
“Unfortunately, because of restrictive, quick-fix recommendations, and treating obesity as a simple ‘eat less, exercise more’ approach, people are set up for long-term failure,” he said. “As a result, they miss out on critical health benefits, such as reduced risk of diabetes and heart disease, that can come from even modest weight loss (3% to 5%) that is sustained 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 effective, they are often limited in scope due to time, training, and financial constraints.
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 safely achieve modest and sustained weight loss.
The researchers conducted a 1-year, parallel-group, randomized clinical trial from June 2018 to November 2019 at the University of North Carolina at Chapel Hill in the US, the University of British Columbia at Kelowna in Canada, and the University of Leeds in the UK. They focused primarily on weight change at 3 and 12 months for 373 participants (272 women), as well as health outcomes and quality of life measurements.
Study participants had a BMI ranging from 25 to 45 (median BMI, 33.8). About 38% of the 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 DIY weight loss program. In the DIY group, participants received information on common publicly available approaches to weight loss, including diet and self-monitoring apps, meal plans, and physical activity recommendations. These participants were left to work alone.
In the commercial program, participants signed up to WW for free and were encouraged to attend weekly workshops, which included a private weight assessment and discussions of successes, problem-solving challenges, and topics related to weight loss and fitness. Behavior change. They also had access to the WW app for food intake, physical activity, online chats with trainers, and an online peer community.
Notably, the WW program now includes simplified requirements for self-monitoring of diet, meaning no need to keep track of over 200 foods by weighing and measuring. Instead, the program automatically assigns point values for certain foods and points to 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 be involved with the data and said it would submit the results regardless of whether the program worked. In addition, WW sites in the US and Canada were unaware of who their typical clients were compared to those enrolled in the study, and after randomizing the participants, the study staff was changed so that they were blinded to the condition of treatment.
“This was a true test of the show, in the real world, with no interaction or influence,” Lutes said. “This allowed us to draw clear, confident and authoritative conclusions based on the results.”
Analysis 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 on the commercial program had an average weight loss of almost 10 pounds (4.4 kg), compared to about 4 pounds (1.7 kg) 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% in the DIY group.
Lutes and colleagues are now looking at additional trial results, including treatment acceptance and any differences between people or groups based on treatment format, modality, and elements. Lutes is also interested in understanding the interplay between physical and mental health.
“Most people in weight loss studies have previously been ruled out if they had depression, anxiety, or other serious mental health condition because it was determined that they would probably not do as well in treatment. We didn’t do that in this study,” he said. “I hope we can make some clear recommendations about the potential benefits of treatment, regardless of any mental health barriers or challenges.”
“An encouraging find”
“While this study is funded by commercial weight loss company and may be at risk of bias … the weight loss results are encouraging and not surprising,” said Bradley Johnston, PhD, associate professor of nutrition at the University from Texas A&M and adjunct professor. at McMaster University, 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, nutrition and clinical experts. 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, those results are largely gone.
“While most randomized controlled trials evaluating interventions for weight loss programs experience regression to the mean (dieters begin to regain their initial weight loss), participants in this commercial program lost more weight at 12 months than at 3 months, an encouraging finding,” he said. he said she.
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 self-esteem-specific quality of life, she noted that the average change in these measures could be important to the public, even if the numbers aren’t statistically significant.
“Still, the authors are to be applauded for measuring 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 aspects of quality of life such as self-esteem, anxiety, sleep quality, and satisfaction with diet, and government funding agencies should avoid funding weight loss trials.” that do not 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 disclosed no relevant financial relationships.
JAMA Network Open. Posted online August 16, 2022. Text complete
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.
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