Advertisement

Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study

      Abstract

      PURPOSE: There have been few randomized controlled trials of commercial weight-loss programs. This ongoing study compares the effects of a self-help program and a commercial program on weight loss and other measures of obesity in overweight and obese men and women.
      SUBJECTS AND METHODS: We report the results of the first 26 weeks of a multicenter, randomized, 2-year study of 423 subjects who had a body mass index of 27 to 40 kg/m2. Subjects were randomly assigned to either a self-help program, consisting of two 20-minute sessions with a nutritionist and provision of printed materials and other self-help resources, or to attendance at meetings of a commercial program (Weight Watchers). Outcome measures were changes in body weight, body mass index, waist circumference, and body fat. Changes in serum homocysteine levels were measured in a subsample of participants during the first 12 weeks.
      RESULTS: After 26 weeks, subjects in the commercial program, as compared with those in the self-help program, had greater decreases in body weight [mean (± SD) −4.8 ± 5.6 vs −1.4 ± 4.7 kg] and body mass index (−1.7 ± 1.9 vs −0.5 ± 1.6 kg/m2, both P <0.001) in intention-to-treat analyses. Among subjects measured at week 26, mean waist circumference (−4.3 ± 10.5 vs −0.7 ± 12.7 cm) and fat mass (−3.8 ± 7.0 vs −1.5 ± 7.6 kg, both P <0.05) also decreased more among subjects in the commercial program. Mean serum homocysteine levels improved in the commercial program compared with self-help (−0.5 ± 1.3 vs 0.9 ± 1.8 μM, P <0.05).
      CONCLUSIONS: A structured commercial weight-loss program is more likely to be effective for managing moderately overweight patients than brief counseling and self-help.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Connolly H.M.
        • Crary J.L.
        • McGoon M.D.
        • et al.
        Valvular heart disease associated with fenfluramine-phentermine.
        N Engl J Med. 1997; 337: 581-588
      1. Paul R. Thomas, ed., and the Food and Nutrition Board, Institute of Medicine, Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity. Weighing the Options: Criteria for Evaluating Weight Management Programs. Washington, DC: National Academy Press, 1995.

        • Levy A.S.
        • Heaton A.W.
        Weight control practices of U.S. adults trying to lose weight.
        Ann Int Med. 1993; 119: 661-666
        • Rippe J.M.
        • Price J.M.
        • Hess S.A.
        • et al.
        Improved psychological well-being, quality of life and health practices in moderately overweight women participating in a 12-week structured weight loss program.
        Obes Res. 1998; 6: 208-218
        • Lowe M.R.
        • Miller-Kovach K.
        • Frye N.
        • Phelan S.
        An initial evaluation of a commercial weight loss program.
        Obes Res. 1999; 7: 51-59
      2. Taylor CB, Stunkard AJ. Public health approaches to weight control. In: Stunkard AJ, Wadden TA, eds. Obesity: Theory and Therapy, 2nd ed. New York: Raven Press, 1993:335–353.

        • Wadden T.A.
        • Foster G.D.
        • Letizia K.A.
        • Stunkard A.J.
        A multicenter evaluation of a proprietary weight reduction program for the treatment of marked obesity.
        Arch Intern Med. 1992; 152: 961-966
      3. The U.S. Weight Loss and Diet Control Market, 5th ed. Tampa, FL: Marketdata Enterprises, 1998.

        • Nygard O.
        • Refsum H.
        • Ueland P.M.
        • Vollset S.E.
        Major lifestyle determinants of plasma total homocysteine distribution.
        Am J Clin Nutr. 1998; 67: 263-270
      4. Eating Smart, National Cattlemen’s Beef Association, Chicago, IL 1996.

      5. Fitting Fitness In, National Cattlemen’s Beef Association, Chicago, IL 1996.

      6. Physical Activity, and Cardiovascular Health. NIH Consensus Statement. December 18–20, 1995;13(3):1–33.

      7. U.S. Department of Health and Human Services, PHS. NHANES III Anthropometric Procedures Video. Washington, DC: US Government Printing Office, Public Health Service, 1996.

        • Sheiner L.B.
        • Rubin D.B.
        Intention-to-treat analysis and the goals of clinical trials.
        Clin Pharmacol Ther. 1995; 57: 6-15
        • Kannel W.B.
        • Cupples L.A.
        • Ramaswami R.
        • et al.
        Regional obesity and risk of cardiovascular disease.
        J Clin Epidemiol. 1991; 44: 183-190
        • National Institutes of Health
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the Evidence Report.
        Obes Res. 1998; 6: 51S-210S
        • Bray G.A.
        • Blackburn G.L.
        • Ferguson J.M.
        • et al.
        Sibutramine produces dose-related weight loss.
        Obes Res. 1999; 7: 189-198
        • Davidson M.H.
        • Hauptman J.
        • DiGirolamo M.
        • et al.
        Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat.
        JAMA. 1999; 281: 235-242
        • Jeffery R.W.
        • Drenowski A.
        • Epstein L.H.
        • et al.
        Long-term maintenance of weight loss.
        Health Psych. 2000; 19: 5-16
        • Volkmar F.R.
        • Stunkard A.J.
        • Woolston J.
        • Bailey R.A.
        High attrition rates in commercial weight reduction programs.
        Arch Intern Med. 1981; 141: 426-428
        • Jeffery R.W.
        • Bjornson-Benson W.M.
        • Rosenthal B.S.
        • et al.
        Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men.
        Prev Med. 1984; 13: 155-168
        • Wadden T.A.
        • Foster G.D.
        • Wand J.
        • et al.
        Clinical correlates of short- and long-term weight loss.
        Am J Clin Nutr. 1992; 56: 271s-274s
        • Rössner S.
        Long-term intervention strategies in obesity treatment.
        Int J Obes. 1995; 19: S29-S33
        • Boushey C.J.
        • Beresford S.A.A.
        • Omenn G.S.
        • Motulsky A.G.
        Quantitative assessment of plasma homocysteine as a risk factor for vascular disease.
        JAMA. 1995; 274: 1049-1057
      8. Position of the American Dietetic Association. Vitamin and mineral supplementation. J Am Diet Assoc. 1996;96:73–77.