The health effects of being overweight or obese have been well studied, but adults in the United States currently weigh more than they have at any point since 1999. However, while providers often seek out methods to help patients address their underlying weight issues in order to treat their presenting conditions, few providers actually offer their patients distinct weight management services. Faced with an endless list of competing priorities and a market saturated with commercial weight-loss programs, providers may be tempted to outsource this service to the Jenny Craigs or Atkins Incs of the world.
The problem? There's a lack of evidence behind commercial programs. Our team conducted an in-depth literature review and assessed a number of recent studies evaluating commercial weight-loss programs. Based on the evidence, here are three reasons why you should think twice before recommending a commercial weight-loss program for your patients:
Among dozens of randomized controlled trials (RCTs) across three meta-analyses, only one RCT had a low risk of bias—the majority had a high risk of selection, detection, and/or attrition bias. This means study participants may not have been sufficiently randomized or blinded to the intervention, and that some individuals may have abandoned the study, skewing the results. Moreover,aside from data bias, researchers noted in one meta-analysis that 21 out of 29 studies received support from the program being studied.
Many RCTs don't have enough data to enable researchers to verify whether trial outcomes are statistically significant. For example, though one meta-analysis includes eight trials evaluating the impact of the Atkins diet on lipids, researchers didn't have sufficient data to make any claims about significance of that impact. This lack of data negates the RCTs' contribution to the evidence base behind the programs.
When studies were able to report on statistical significance, they overwhelmingly reported insignificant effects. Most RCTs focus on weight loss and changes in systolic and diastolic blood pressure and lipids (HDL, LDL, and total cholesterol and triglycerides) to evaluate the impact of commercial weight-loss programs. But across meta-analyses, when studies evaluate the same measures, they rarely achieve significance across all studies.
These findings do not mean that commercial programs never work. A few studies have found that Weight Watchers and Jenny Craig—the two programs with the largest market share—can increase weight loss and improve lipid counts when compared with behavioral counseling or basic patient education. But overall, research shows that these programs can't solve the obesity crisis alone, and referring patients to them is unlikely to have a meaningful, long-term impact.
Instead, providers should take a multifaceted approach to support weight management. Combine interventions related to diet (e.g., working with a dietician, facilitating calorie counting), behavior change (e.g., providing feedback on patient progress), and physical activity. This approach not only engages patients in their weight-loss journey, but it also ingrains healthy choices into all aspects of patients' lifestyles.
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