Efficacy of Commercial Weight-Loss Programs: An Updated Systematic Review
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Efficacy of Commercial Weight-Loss Programs: An Updated Systematic Review. Ann Intern Med.2015;162:501-512. [Epub 7 April 2015]. doi:10.7326/M14-2238
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Fitness and exercise are better than commercial weight loss programs
1. Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM et al. Efficacy of Commercial Weight Loss Programs An Updated Systemic Review. Ann Intern Med. 2015;162:501-512. doi:10.7326/M14-2238
2. The Look AHEAD Research Group. Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. N Engl J Med 2013;369:145-54.
doi: 10.1056/NEJMoa1212914
3. Sjostrom L, Narbo K, Sjostrom D, Karason K, Larsson B, Wedel H et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007;357:741-752. doi: 10.1056/NEJMoa066254
4. Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, et al. (2015) Intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials. PLoS ONE 10(3): e0121993. doi:10.1371/journal.pone.0121993
5. Lee D-c, Sui X, Artero EG, Lee I-M, Church T, McAuley PA et al. Long-Term Effects of Changes in Cardiorespiratory Fitness and Body Mass Index on All-Cause and Cardiovascular Disease Mortality in Men The Aerobics Center Longitudinal Study. Circulation 2011;124:2483-2490. doi: 10.1161/CIRCULATIONAHA.111.038422
Comment
[1] Bradley D, et al, The Incremental Value of Medical Nutrition Therapy in Weight Management. Managed Care, January 2013, pp 40-45.
[2] 2014 Food and Health Survey, International Food Information Council Foundation. http://www.foodinsight.org/surveys/2014-food-and-health-survey.
[3] Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, Bipartisan Policy Center, June 2014. http://bipartisanpolicy.org/library/report/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention
A biased review of the efficacy of commercial weight-loss programs
Further, in what the authors claim was an attempt to reduce publication bias, they chose to include unpublished studies, all of which were obtained from the weight-loss programs themselves, and all of which provided favorable outcomes for the companies. This increased publication bias rather than decreasing it. In fact, the vast majority of included studies that Gudzune et al focused on in their “systematic” review were funded by the same companies that Gudzune et al recommend in their conclusions. One exception, which was not funded by these “market leaders,” was the randomized clinical trial that Gudzune et al omitted in their efficacy review (their reference 36).
Of the few studies that were included in this review, the researchers stated that the vast majority conducted intent-to-treat analyses (ITT). However, upon further investigation, analyses labeled as ITTs only included completers (e.g., their reference 22). This also could have inflated the reported efficacy results for the “market leaders” since inevitably all those who completed the program are likely to have a higher percentage of weight loss compared to those who didn’t.
In short, Gudzune et al used biased methods, which produced a non-comprehensive review that is not likely to represent the efficacy of commercial weight-loss programs.
1. Gudzune KA, Doshi RS, Mehta AK, et al. Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med. 2015;162 (7):501-12.
2. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312:923- 33. [PMID: 25182101] doi:10.1001/jama.2014.10397.
Presenting Overall Effectiveness in Addition to Comparative Effectiveness
1. Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med. 2015;162(7):501-12.
2. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153(3):147-57.
3. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and risk factors among overweight premenopausal women: a randomized trial. JAMA. 2007;297(9):969-77.
4. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229-41.
5. Yancy WS, Jr., Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;140(10):769-77.
6. Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D, et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care. 2009;32(7):1147-52.
7. Wee CC. The role of commercial weight-loss programs. Ann Intern Med. 2015;162(7):522-3.
Author's Response
Yancy and colleagues note that the term “behavioral counseling” might not completely describe the comparator interventions that included counseling on diet, exercise, and/or behavior modification of varying intensities. We acknowledge the heterogeneity among counseling comparators, which contributed to why we did not present meta-analyses. We provided details about all comparator and intervention arms in Supplemental Table 4. Second, they expressed concern about the presentation of only comparative effectiveness results. Our stated purpose was to compare weight loss of commercial weight-loss programs versus control/education or counseling among overweight/obese adults. Thus, we emphasized comparative results to aid clinicians who are often faced with weighing different treatment options for their patients. In fact, obesity counseling in clinical settings may become even more relevant, as it may be increasingly available to patients given recent benefit expansions within Medicare and through the Patient Protection and Affordable Care Act (3-4).
We briefly address comments made by Alley and colleagues. Our goal was to update a prior systematic review on commercial weight-loss programs (5), and therefore, we developed a protocol a priori based on eligibility criteria from that prior review (Supplemental Table 3). We applied these criteria when screening all abstracts and articles, which resulted in the ultimate inclusion of 45 studies – 39 randomized controlled trials that were included for all outcomes and 6 other trials that were included only in the assessment of harms (Appendix Figure). Their letter includes several inaccurate statements related to the eligibility, inclusion and classification of articles. In particular, we provide clarification regarding their assertion that we included unpublished data. While we considered unpublished data provided by commercial programs, we did not include any in our review as none met our eligibility criteria.
References
1. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129:S102-38.
2. Moyer VA, U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012. 157:373-8.
3. Centers for Medicare & Medicaid Services. Intensive Behavioral Therapy for Obesity. February 3, 2012. Accessed online at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R142NCD.pdf
4. Congressional Budget Office. Updated estimates of the insurance coverage provisions of the Affordable Care Act. February 2014. Accessed at www.cbo.gov/sites/default/files/cbofiles/attachments /45010-breakout-AppendixB.pdf
5. Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005;142:56-66.