Review of Commercial Weight-Loss Programs
So after yesterday’s CMAJ editorial, in which Yoni and I blasted some practices of commercial weight loss programs, created a flurry of media interest (including on the front page of the Globe & Mail as well as national TV), here is the best available sytematic review of commercial weight-loss programs in the US, published in the Annals of Internal Medicine by Tsai and Wadden from the University of Pennsylvania School of Medicine in 2005.
The authors reviewed company Web sites, conducted telephone discussion with company representatives, and searched the MEDLINE database.
All randomized trials of at least 12 weeks in duration that enrolled only adults and assessed interventions as they are usually provided to the public, or case series that met these criteria, stated the number of enrollees, and included a follow-up evaluation that lasted 1 year or longer were examined.
Programs studied included eDiets.com, Health Management Resources, Take Off Pounds Sensibly, OPTIFAST, and Weight Watchers.
Of 3 randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at 2 years - this is very much in the same ball park as the long-term results of some of the best academically run behavioral programs. One randomized trial and several case series of medically supervised very-low-calorie diet programs (like OPTIFAST) found that patients who completed treatment lost approximately 15% to 25% of initial weight.
All programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years.
Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss.
The authors note that because many studies did not control for high attrition rates, the reported results are probably a best-case scenario. Thus, with the exception of 1 trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal.
Nevertheless, programs like Weight Watchers (a member of the Edmonton WeightWise (WW) Community Network) or OPTIFAST (often used in WW as a rescue strategy in Stage 4 patients and also provided by a WW Community Network Partner) may be effective in some individuals and can be part of a long-term weight management strategy for selected patients.
However, clearly most commercial weight-loss programs (and products) have yet to be studied in large controlled trials.
So how are commercial programs different from ethical, evidence-based programs, such as Alberta Health Services’, Edmonton-based WW program? While we may still have high attrition rates and results that are in line with reported outcomes for behavioural, pharmacological and surgical trials (i.e. weight loss in the range of 5 to 35%) - at least we do not claim, advertise or sell services that are not based on best evidence.
In fact, a notable feature of the WW program is an orientation session that every patient has to attend before being seen in the clinic, which certainly leaves no doubt as to the challenges and limited magnitude of long-term weight loss that can be expected - for some patients just stopping the gain is success!
Furthermore, as befits an academic-based program, WW patients on the waiting list as well as those receiving medical and/or surgical treatment arms are being prospectively followed in a 3-year study funded by the Canadian Institutes of Health Research (APPLES).
We recognize that access to and options for obesity treatment are limited within the public health care system. However, this should not serve as an excuse to scam individuals challenged by excess weight out of their money by promising results that are inconsistent with the best evidence. WW does not recognize as Community Partners weight-loss programs, whose results are solely based on anecdotes or testimonials (always a Red Flag to watch out for).
AMS
Edmonton, Alberta
by Arya M. Sharma, MD
Wednesday, February 18, 2009
Weight Loss Miracles
by Arya M. Sharma, MD
Today’s edition of the Canadian Medical Association Journal (CMAJ) features an editorial co-authored by Yoni Freedhoff (of Weighty Matters fame) and myself on the largely unregulated weight-loss industry that is often heavy on promises but light on evidence.
The reason we slam the often preposterous weight-loss claims is not because Yoni and I are against commercial enterprise - both of us make a living treating patients for obesity. The reason we wrote the editorial (together with the editorial team of CMAJ), is because we believe that patients, who present with a legitimate and potentially deadly and disabling chronic disease, should receive proper medical care based on the best available scientific evidence. We feel that the delivery of this care, not unlike care for other medical conditions, is best left in the hands of licensed and regulated health professionals. When regulated health professionals themselves engage in pseudoscience, it is up to the colleges and professional bodies to step in and ensure that obesity care is delivered in an ethical and professional manner with due regard to best evidence.
Indeed, there are numerous “private” centers and practicing health professionals that offer a wide range of credible, ethical and evidence-based obesity treatments - many of these can be found among the extensive Weight Wise Community Network.
Much of the confusion about what works and what doesn’t is perhaps due to the mistaken notion that weight loss in itself is a measure of success. As I always remind my patients, it never matters how much you lose, only how much you can keep off.
Unfortunately, while most patients expect to lose (and keep off) half their weight, even surgery on average only delivers around 30% long-term weight loss.
The idea, that results rivaling or even exceeding those seen with bariatric surgery can be achieved by simply taking a “natural” product bought off a super market shelf or the internet, which promises to help you shed pounds by “cleansing” your body or “boosting” your metabolism (all with no side effects and without having to move a muscle), is simply preposterous. Believe me, if such a product existed, I’d be the first to prescribe it to my patients.
The sad reality is that there is no “magic” solution - long-term weight management requires strict control of energy balance - best achieved by careful adjustment of dietary caloric intake combined with increased activity. Yes, at times, prescription drugs, low-calorie diets, or even surgery will be necessary - but even these are not magical cures - just evidence-based treatments for the chronic medical condition called obesity.
The following is a simple consumer guide to recognizing fraudulent weight loss products:
Mistrust any product that claims to
- cause weight loss of two pounds or more a week for a month or more without dieting or exercise
- cause substantial weight loss no matter what or how you eat
- cause permanent weight loss (even when you stop using product)
- safely enable consumers to lose more than three pounds per week for more than four weeks
- cause substantial weight loss for all users
- cause substantial weight loss by wearing it on the body or rubbing it into the skin
For a comprehensive document on how to recognize fraudulent products from the US Bureau of Consumer Protection click here. You may also want to check out the add for “Fat Foe” at the head of this post.
Incidentally, the CMAJ editorial is accompanied by an article on Yoni’s remarkable private collection of “Believe it or Not”-style weight-loss treatments - these indeed need to be seen to be believed. Additional photographs of preposterous weight-loss products can be found on the CMAJ website.
I am certain that this CMAJ editorial will cause a stir in the media - will it stop people from spending their money on useless diet aids and weight-loss gizmos - hardly.
AMS
Edmonton, Albert
by Arya M. Sharma, MD
Today’s edition of the Canadian Medical Association Journal (CMAJ) features an editorial co-authored by Yoni Freedhoff (of Weighty Matters fame) and myself on the largely unregulated weight-loss industry that is often heavy on promises but light on evidence.
The reason we slam the often preposterous weight-loss claims is not because Yoni and I are against commercial enterprise - both of us make a living treating patients for obesity. The reason we wrote the editorial (together with the editorial team of CMAJ), is because we believe that patients, who present with a legitimate and potentially deadly and disabling chronic disease, should receive proper medical care based on the best available scientific evidence. We feel that the delivery of this care, not unlike care for other medical conditions, is best left in the hands of licensed and regulated health professionals. When regulated health professionals themselves engage in pseudoscience, it is up to the colleges and professional bodies to step in and ensure that obesity care is delivered in an ethical and professional manner with due regard to best evidence.
Indeed, there are numerous “private” centers and practicing health professionals that offer a wide range of credible, ethical and evidence-based obesity treatments - many of these can be found among the extensive Weight Wise Community Network.
Much of the confusion about what works and what doesn’t is perhaps due to the mistaken notion that weight loss in itself is a measure of success. As I always remind my patients, it never matters how much you lose, only how much you can keep off.
Unfortunately, while most patients expect to lose (and keep off) half their weight, even surgery on average only delivers around 30% long-term weight loss.
The idea, that results rivaling or even exceeding those seen with bariatric surgery can be achieved by simply taking a “natural” product bought off a super market shelf or the internet, which promises to help you shed pounds by “cleansing” your body or “boosting” your metabolism (all with no side effects and without having to move a muscle), is simply preposterous. Believe me, if such a product existed, I’d be the first to prescribe it to my patients.
The sad reality is that there is no “magic” solution - long-term weight management requires strict control of energy balance - best achieved by careful adjustment of dietary caloric intake combined with increased activity. Yes, at times, prescription drugs, low-calorie diets, or even surgery will be necessary - but even these are not magical cures - just evidence-based treatments for the chronic medical condition called obesity.
The following is a simple consumer guide to recognizing fraudulent weight loss products:
Mistrust any product that claims to
- cause weight loss of two pounds or more a week for a month or more without dieting or exercise
- cause substantial weight loss no matter what or how you eat
- cause permanent weight loss (even when you stop using product)
- safely enable consumers to lose more than three pounds per week for more than four weeks
- cause substantial weight loss for all users
- cause substantial weight loss by wearing it on the body or rubbing it into the skin
For a comprehensive document on how to recognize fraudulent products from the US Bureau of Consumer Protection click here. You may also want to check out the add for “Fat Foe” at the head of this post.
Incidentally, the CMAJ editorial is accompanied by an article on Yoni’s remarkable private collection of “Believe it or Not”-style weight-loss treatments - these indeed need to be seen to be believed. Additional photographs of preposterous weight-loss products can be found on the CMAJ website.
I am certain that this CMAJ editorial will cause a stir in the media - will it stop people from spending their money on useless diet aids and weight-loss gizmos - hardly.
AMS
Edmonton, Albert
Tuesday, February 17, 2009
Sunday, February 01, 2009
When you feel like you cant go on, when you cant do any more....
My profession is Fitness Trainer and Healthy Lifestyle Coach. I specialize in transforming lives, helping people with weight management/loss, self image and self esteem issues [mainly for women]. Many don't know this, as I usually write about life, love, passion and I tend to post spiritually inclined messages. However, weight, self, and body management has very little to do with the mere physical realms of life. If it were the case, I would not have a job ... smile :)
It is HARD to lose weight. It is HARD to get in shape, even harder to STAY in shape. It is HARD to stick to a disciplined routine, when we run out of excuses to enjoy egg whites and cant figure out another way to make a mixed green salad exciting or to pull in another 30 minutes on the treadmill.... We all have limits so to speak that often have the strength to stop us at the worst times - when we are just inches away from the END; the PRIZE.
What I teach my clients (this is where the famous LOVE/HATE relationships are born, strengthen, and come alive) is, When you feel like you cant go on or you cant do any more...; you CRANK IT UP A NOTCH. You work harder, you stand taller, you speak louder, you fight braver. YOU CRANK IT UP A NOTCH.
As an example, when you feel like you cant fight the traffic at 5 PM do you just stop on the highway, do you speed up and slam into the guy in front of you? No. You take a deep breath, find a way to make the way to your destination enjoyable, and drive it home - you make it happen. Because THAT is what you are set out to do. Unless you fancy a night on the roadside instead of your comfy bed with someone who makes your sleep even sweeter.
So next time you complain how hard it is to stick to your fitness/diet program, or the thought of th e treadmill makes you see double and freeze your steps, or you feel like you have nothing more to give to a situation that claims beyond your all, just CRANK IT UP A NOTCH. Reach beyond your[self], raise your bar you set on yourself. You will be amazed what you are capable of. And THAT is going to be only the beginning of your true potential.
Make it happen!
_MK
My profession is Fitness Trainer and Healthy Lifestyle Coach. I specialize in transforming lives, helping people with weight management/loss, self image and self esteem issues [mainly for women]. Many don't know this, as I usually write about life, love, passion and I tend to post spiritually inclined messages. However, weight, self, and body management has very little to do with the mere physical realms of life. If it were the case, I would not have a job ... smile :)
It is HARD to lose weight. It is HARD to get in shape, even harder to STAY in shape. It is HARD to stick to a disciplined routine, when we run out of excuses to enjoy egg whites and cant figure out another way to make a mixed green salad exciting or to pull in another 30 minutes on the treadmill.... We all have limits so to speak that often have the strength to stop us at the worst times - when we are just inches away from the END; the PRIZE.
What I teach my clients (this is where the famous LOVE/HATE relationships are born, strengthen, and come alive) is, When you feel like you cant go on or you cant do any more...; you CRANK IT UP A NOTCH. You work harder, you stand taller, you speak louder, you fight braver. YOU CRANK IT UP A NOTCH.
As an example, when you feel like you cant fight the traffic at 5 PM do you just stop on the highway, do you speed up and slam into the guy in front of you? No. You take a deep breath, find a way to make the way to your destination enjoyable, and drive it home - you make it happen. Because THAT is what you are set out to do. Unless you fancy a night on the roadside instead of your comfy bed with someone who makes your sleep even sweeter.
So next time you complain how hard it is to stick to your fitness/diet program, or the thought of th e treadmill makes you see double and freeze your steps, or you feel like you have nothing more to give to a situation that claims beyond your all, just CRANK IT UP A NOTCH. Reach beyond your[self], raise your bar you set on yourself. You will be amazed what you are capable of. And THAT is going to be only the beginning of your true potential.
Make it happen!
_MK
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