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Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear.
To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults.
MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff.
Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only).
Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias.
We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs.
Many trials were short (<12 months), had high attrition, and lacked blinding.
Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed.
Primary Funding Source:
None. (PROSPERO: CRD4201-4007155)
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Author, Article, and Disclosure Information
Kimberly A. Gudzune,
From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.
Financial Support: Dr. Gudzune was supported by a career development award from the National Heart, Lung, and Blood Institute (K23HL116601). Ms. Doshi was supported by the Johns Hopkins medical student summer research program. Mr. Jacobs was supported by the medical student research program in diabetes at JHU-UMD Diabetes Research Center (National Institute of Diabetes and Digestive and Kidney Diseases grant P30DK079637). Dr. Bleich was supported by a career development award from the National Heart, Lung, and Blood Institute (1K01HL096409).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2238.
Corresponding Author: Kimberly Gudzune, MD, MPH, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-621, Baltimore, MD 21287; e-mail, gudzune@jhu.
Current Author Addresses:Dr. Gudzune: Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-621, Baltimore, MD 21287.
Ms. Doshi: The Johns Hopkins Hospital, 600 North Wolfe Street, Harvey/Nelson Room 110, Baltimore, MD 21287.
Dr. Mehta: Department of Medicine, The Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224.
Dr. Chaudhry: The Johns Hopkins University, University Health Services, 933 North Wolfe Street, Baltimore, MD 21205.
Mr. Jacobs: The University of Maryland School of Medicine, Office of Student Affairs, 655 West Baltimore Street, Baltimore, MD 21201.
Mr. Vakil: Rutgers Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854.
Dr. Lee: Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287.
Dr. Bleich: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 454, Baltimore, MD 21205.
Dr. Clark: Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-617, Baltimore, MD 21287.
Author Contributions:Conception and design: K.A. Gudzune, R.S. Doshi, D.K. Jacobs, S.N. Bleich, J.M. Clark.
Analysis and interpretation of the data: K.A. Gudzune, R.S. Doshi, A.K. Mehta, D.K. Jacobs, S.N. Bleich, J.M. Clark.
Drafting of the article: K.A. Gudzune, R.S. Doshi, A.K. Mehta, D.K. Jacobs, S.N. Bleich.
Critical revision of the article for important intellectual content: K.A. Gudzune, R.S. Doshi, A.K. Mehta, Z.W. Chaudhry, D.K. Jacobs, J.M. Clark.
Final approval of the article: K.A. Gudzune, R.S. Doshi, D.K. Jacobs, R.M. Vakil, C.J. Lee, S.N. Bleich, J.M. Clark.
Statistical expertise: K.A. Gudzune.
Administrative, technical, or logistic support: K.A. Gudzune.
Collection and assembly of data: K.A. Gudzune, R.S. Doshi, A.K. Mehta, Z.W. Chaudhry, D.K. Jacobs, R.M. Vakil, C.J. Lee.
* Dr. Gudzune and Ms. Doshi contributed equally to this work.