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Retention rates and weight loss in a commercial weight loss program

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  • The Cooper Institute

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To evaluate and describe retention rates and weight loss in clients participating in a commercial weight loss program. A total of 60 164 men and women ages 18-79 years who enrolled in the Jenny Craig Platinum program between May 2001 and May 2002. Retention rates, mean weight loss and percent weight loss were calculated on a weekly basis for the 52-week period following initial enrollment in the weight loss program. Clients were categorized based on final week of participation in the program (weeks 1-4, weeks 5-13, weeks 14-26, weeks 27-39 and weeks 40-52) and weight loss was calculated at final week. A subgroup of clients was identified based on attendance through 13, 26 and 52 weeks. Mean and percent weight loss was calculated for these subgroups of clients. Of the 60 164 men and women who enrolled in the weight loss program, 73% were retained in the program after 4 weeks, 42% at 13 weeks, 22% at 26 weeks and 6.6% at 52 weeks. Clients who dropped out of the program during the first 4 weeks lost 1.1+/-1.6% (mean+/-s.d.) of their initial body weight, whereas clients who dropped out between 40 and 52 weeks lost 12.0+/-7.2%. Clients in the 13-week, 26-week and 52-week cohorts lost 8.3+/-3.3, 12.6+/-5.1 and 15.6+/-7.5% of their initial body weight, respectively. Weight loss was greater among clients who were retained in the program longer. The findings from this study suggest that a commercial weight loss program can be an effective weight loss tool for individuals who remain active in the program.
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ORIGINAL ARTICLE
Retention rates and weight loss in a commercial
weight loss program
CE Finley
1
, CE Barlow
1
, FL Greenway
2
, CL Rock
3
, BJ Rolls
4
and SN Blair
1
1
The Cooper Institute, Center for Epidemiologic Research, Dallas, TX, USA;
2
Pennington Biomedical Research Center,
Outpatient Clinic Unit, Baton Rouge, LA, USA;
3
Department of Family and Preventive Medicine, University of California,
San Diego Medical Center, La Jolla, CA, USA and
4
Department of Nutritional Sciences, Penn State University, University
Park, PA, USA
Objective: To evaluate and describe retention rates and weight loss in clients participating in a commercial weight loss program.
Subjects: A total of 60 164 men and women ages 18–79 years who enrolled in the Jenny Craig Platinum program between May
2001 and May 2002.
Methods: Retention rates, mean weight loss and percent weight loss were calculated on a weekly basis for the 52-week period
following initial enrollment in the weight loss program. Clients were categorized based on final week of participation in the
program (weeks 1–4, weeks 5–13, weeks 14–26, weeks 27–39 and weeks 40–52) and weight loss was calculated at final week. A
subgroup of clients was identified based on attendance through 13, 26 and 52 weeks. Mean and percent weight loss was
calculated for these subgroups of clients.
Results: Of the 60 164 men and women who enrolled in the weight loss program, 73% were retained in the program after 4
weeks, 42% at 13 weeks, 22% at 26 weeks and 6.6% at 52 weeks. Clients who dropped out of the program during the first 4
weeks lost 1.171.6% (mean7s.d.) of their initial body weight, whereas clients who dropped out between 40 and 52 weeks lost
12.077.2%. Clients in the 13-week, 26-week and 52-week cohorts lost 8.373.3, 12.675.1 and 15.677.5% of their initial
body weight, respectively.
Conclusion: Weight loss was greater among clients who were retained in the program longer. The findings from this study
suggest that a commercial weight loss program can be an effective weight loss tool for individuals who remain active in the
program.
International Journal of Obesity advance online publication, 6 June 2006; doi:10.1038/sj.ijo.0803395
Keywords: commercial weight loss program; retention rates; weight management
Introduction
The growing prevalence of obesity and overweight has
increased the need to find effective weight loss programs.
For men and women who are overweight or obese, a modest
weight loss of 5–10% of their body weight can lead to
significant decreases in the co-morbidities associated with
overweight and obesity.
1,2
In the US population, estimates of
the prevalence of attempts to lose weight range from 38 to
44% in women and 24 to 29% in men.
3,4
Americans spend
over $33 billion annually on a variety of weight loss products
and services.
5
These weight loss services range from self-help
attempts at dieting or physical activity, professional counsel-
ing, pharmacological interventions and surgical interven-
tions to commercial weight loss programs with and without
structured diets.
The number of commercial weight loss programs has
increased to meet the need of consumers, but recent reviews
of commercial weight loss programs have exposed the lack of
scientific, peer-reviewed data from most programs.
6,7
In their
review, Tsai and Wadden
7
suggested that prominent com-
mercial weight loss programs should carry out ‘naturalistic
studies’ following a large cohort to determine retention rates
and weight loss at discontinuation. Such studies would
provide consumers with adequate information to make
informed decisions about a commercial weight loss program
before joining. To address the relative lack of ‘naturalistic
studies’ from commercial weight loss programs that has been
identified in recent reviews, we performed analyses using
data from a commercial weight loss program. The purpose of
the study is to present data from a ‘naturalistic study’ of one
Received 12 October 2005; revised 31 March 2006; accepted 10 April 2006
Correspondence: CE Finley, The Cooper Institute, 12330 Preston Road, Dallas,
TX 75230, USA.
E-mail: cfinley@cooperinst.org
International Journal of Obesity (2006) 1–7
&
2006 Nature Publishing Group All rights reserved 0307-0565/06
$
30.00
www.nature.com/ijo
commercial program, with the view that this information
may be useful to health-care professionals and individuals
seeking support for weight management. The specific
objectives of this study were to evaluate retention rates and
weight loss in clients participating in the weight loss
program and to identify cohorts of committed clients based
on attendance through 13, 26 and 52 weeks of the program
and document their weight loss experiences.
Participants and methods
The weight loss program
Jenny Craig was established in 1983 with a mission to help
clients achieve their weight management goals through a
behavioral change approach, including healthy eating, an
active lifestyle and a balanced approach to living. The
program, designed by registered dietitians in consultation
with a multidisciplinary Medical Advisory Board, consists of
weekly one-on-one meetings with a trained consultant at a
community-based facility who tailors the program to the
client’s food, menu and physical activity preferences while
providing behavioral strategies to develop a balanced life-
style for long-term weight management. Consultants also
provide follow-up telephone and e-mail contacts with the
clients along with Website/message board availability. Con-
sultants help clients choose a realistic goal weight, based on
their current weight and a healthy weight that corresponds
to a body mass index range of 18.5–24.9 kg/m
2
and provide
advice on how to increase physical activity. The program is
designed to result in an average weight loss of 1 to 2 pounds
per week to reach the client’s goal weight. There is no
minimum or maximum weight restriction for clients enrol-
ling in the program because desired weight loss may range
from 5 pounds to over 100 pounds depending on the client’s
needs. The average cost of enrolling in the program during
the time period of the study was $180, with enrollment costs
ranging from $20 to $399 depending on promotions and
discounts. In addition to the cost of enrollment, clients
typically spend about $20 to $30 more per week on food
when active in the program as compared to when they are
off the program. This compares with data from the
Consumer Expenditure Survey, which estimates that US
consumers typically spend $59 per week on food.
8
An
estimate of the cost of the program for a 1-year membership
is $1480, which includes enrollment and weekly food costs
that are above what consumers would typically spend on
food.
The healthy eating component of the diet and lifestyle
modification program consists in defining an energy-
reduced diet of 1200–2000 kcal/day based on the client’s
energy requirements. This plan includes prepackaged pre-
pared food items and incorporates meal additions such as
vegetables, fruit and whole grains to help reduce the overall
energy density of the diet. The prepackaged foods are
generally provided at the weekly meeting with the con-
sultant, and food selections are determined by the prefer-
ences of the client and how well they fit into the overall meal
plan. Clients also receive counseling for making appropriate
food choices in situations outside the context of prepackaged
foods (e.g., eating in restaurants, eating when traveling,
meals and snacks based on usual food choices).
Consultants also counsel clients on increasing physical
activity by setting realistic goals that are based on the
readiness, capabilities and preferences of the client. In
general, the goal is for clients to accumulate at least 30 min
of physical activity on 5 or more days of the week, based on
recommendations from the Centers for Disease Control and
Prevention, the American College of Sports Medicine
9
and
the office of the US Surgeon General.
10
This commercial
program utilizes extensive written materials and other
media, such as CDs that promote increasing physical activity
and videotapes to facilitate structured exercise activities.
The present study includes participants from the Platinum
Program. The Platinum Program is a year-long program in
which clients receive additional incentives to remain active
in the program such as a walking audio program, a
cookbook, and discounts for family members.
Participants
Clients eligible for the study were 65 154 men and women
ages 18–79 years who enrolled in the Platinum Program in
the United States between May 2001 and May 2002.
Employees of the company and clients interested in main-
taining weight rather than losing weight (defined as
‘Maintenance’ clients by the company) were not included
in the sample for the analyses presented here. Of those
initially eligible to be included in the analyses, 139 were
excluded owing to unreliable baseline weight and 4851 were
excluded owing to unrealistic weekly weight loss, defined as
a change in weight of 15 pounds or more in 1 week, leaving
60 164 men and women in the study.
Data collection
A trained consultant obtained baseline weight and calcu-
lated a goal weight when the client registered for the
program. Weight data were entered into a computer program
for tracking purposes. Weight measurements were obtained
when the client returned for the weekly one-on-one
consultation. We are limited in the amount of demographic
data available for the analysis owing to variations in data
collection practices over time and across community centers.
Approximately, 25% of clients are missing data on gender,
20% on age, 33% on marital status and 66% on occupation.
For this reason, retention rates and weight loss data are
pooled for men and women and stratification by demo-
graphic variables is not shown for some of the analyses.
Data analysis
We calculated retention rates on a weekly basis for the
52-week period following initial enrollment. Clients were
Retention in a commercial weight loss program
CE Finley et al
2
International Journal of Obesity
considered dropouts if they had missing weight data for 6 or
more consecutive weeks during the 52-week period. If the
client was a dropout, the final week was defined as the last
week with weight data before missing 6 or more consecutive
weeks. We calculated mean and percent weight loss at the
final week for all clients. We then categorized clients into
groups based on their percent weight loss and calculated
mean and median weight for the final week and determined
if retention differed between groups. The following group-
ings were used: clients who lost o5, 5–10, 10.1–15, 15.1–20
and 420% of their baseline weight. We tested for differences
across groups using analysis of variance.
We identified clients with a high level of commitment to
the program based on attendance at three different time
periods. To be included in the 13-, 26-, or 52-week cohort,
clients must have attended at least 85% of their weekly
consultations during the initial 13-week period (11 of 13
consultations), 26-week period (23 of 26 consultations) or
52-week period (46 of 52 consultations), respectively. For this
subanalysis, we excluded clients with missing data on
gender. We calculated mean weight at baseline, and mean
weight loss and percent weight loss at follow-up stratified by
gender for each cohort. All data analyses were conducted
with SAS version 8.2 (SAS Institute, Cary, NC, USA, 1999).
Results
Retention rates for all clients are shown in Figure 1. Of the
60 164 men and women who began the program, 73% were
retained in the program after 4 weeks (1 month), 42%
remained at 13 weeks (3 months), 22% at 26 weeks (6
months) and 6.6% were retained in the program for 52
weeks. After 10 weeks in the program, 50% of the
participants had dropped out of the program, although
specific data on the reason for discontinuing in the program
are not available in this data set.
The mean baseline weight for the 60 164 men and women
in the study was 89.8721.2 kg (mean7s.d.) and the mean
weight loss during participation in the program was
5.075.5 kg. Percent weight loss is directly associated with
the amount of time a client remains in the program
(Figure 2). Mean baseline weight, mean weight loss and
percent weight loss at dropout or last measurement was
significantly greater for clients who remained in the program
longer (Table 1). Clients who dropped out of the program
during the first 4 weeks lost about 1% of their initial body
weight compared with about 12% weight loss for clients who
remained in the program at least 40 weeks (P for trend:
o0.0001). Clients who dropped out of the program between
weeks 14 and 26 (4–6 months) lost an average of 7.3% of
their baseline body weight, a meaningful weight loss for
reducing health risks associated with overweight and obesity.
When we stratified by percent of baseline weight loss, 56%
of clients had a weight loss of less than 5% of their baseline
weight, whereas 26.5% lost 5–10% of their baseline weight
and 17.5% lost over 10% of their baseline weight (Table 2).
The mean final week for clients who lost less than 5% of their
baseline weight was 8.5 weeks, compared with 20.5 weeks for
clients who lost between 5 and 10% of their baseline weight
and 31 weeks for clients who lost 10.1–15% of their baseline
weight.
Mean weight loss for the 13-, 26- and 52-week cohorts by
gender are shown in Tables 3 and 4. Women and men
experienced similar weight loss trends in all cohorts. Clients
in the 52-week cohort had a larger baseline weight and
weight loss compared to clients in the 13- and 26-week
cohorts. Women and men who attended at least 11 of their
consultations at 13 weeks lost approximately 8% of their
body weight. Men and women in the 26-week cohort lost
0
10
20
30
40
50
60
70
80
90
100
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
Weeks
Figure 1 Percentage of 60 164 clients retained at each week during a 52-week time period.
Retention in a commercial weight loss program
CE Finley et al
3
International Journal of Obesity
approximately 12% of their baseline weight. Clients in the
52-week cohort experienced the greatest weight loss, with
women losing about 16% and men losing about 13% of their
baseline weight. All three cohorts experienced a greater
weight loss compared to the entire client sample.
Discussion
Retention is directly associated with weight loss in this study
of clients enrolled in the commercial diet and lifestyle
modification program between May 2001 and May 2002.
Although attrition in the study was high, those who
remained in the program longer lost more weight. Clients
who lost between 10.1 and 15% of baseline weight remained
active in the program an average of 31 weeks. Clients who
remained in the program longer also had a higher baseline
weight suggesting that weight loss and retention may also be
related to baseline weight, perhaps because these individuals
had more weight to lose to reach their goal weight and thus
took more time to achieve a weight that was acceptable to
them. Additionally, clients who displayed greater commit-
ment to the program as evidenced by higher attendance rates
at weekly consultations lost more weight compared with
clients who were less committed.
The attrition rates among clients in this study are similar
to previously published studies of commercial weight loss
programs, although higher than those observed in con-
trolled clinical trials.
11–16
Volkmar et al.
17
found high
attrition rates in a study of 108 women enrolled in a
commercial weight loss program. In their study, 50% of the
women had dropped out of the program by 6 weeks and 70%
by 12 weeks. By comparison, a larger percentage of clients in
the present analyses were retained at both 6 and 12 weeks.
Approximately, 32% of the clients were no longer active in
the program at 6 weeks and 53% had dropped out by 12
weeks. Data on the reason for dropout or reason for
0
2
4
6
8
10
12
14
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
Weeks
Percent Weight Loss
Figure 2 Percent weight loss at final week of attendance for 60 164 clients.
Table 1 Mean and percent weight loss for 60 164 clients by final week of attendance
Final week N Baseline weight (kg) Weight loss (kg) Percent weight loss
Mean7s.d. Mean7s.d. Mean7s.d.
Weeks 1–4 (month 1) 16 465 89.4721.9 1.071.5 1.171.6
Weeks 5–13 (months 2–3) 18 377 89.3721.2 3.872.9 4.373.0
Weeks 14–26 (months 4–6) 12 042 89.6720.4 6.674.4 7.374.5
Weeks 27–39 (months 7–9) 5698 90.8720.8 8.575.8 9.475.6
Weeks 40–52 (months 10–12) 7582 93.3721.4 11.578.2 12.377.2
P for trend o0.0001 o0.0001 o0.0001
Table 2 Mean and median final week of attendance for 60 164 clients
stratified by percent weight loss group
Percent weight loss
group
N (%) Final week
mean7s.d.
Final week median
o5 33760 (56.1) 8.5710.5 5
5–10 15929 (26.5) 20.5713.8 16
10.1–15 6716 (11.2) 31.0714.3 28
15.1–20 2468 (4.1) 38.9712.7 41
420 1291 (2.2) 45.679.7 52
P for trend: o0.0001
Retention in a commercial weight loss program
CE Finley et al
4
International Journal of Obesity
remaining in the program are not available for these clients,
but based on other data from this commercial program,
potential reasons for leaving the program include cost,
scheduling conflicts/travel, tiring of the food, unrelated
health issues, meeting weight loss goals and/or stopped
losing weight. Customer satisfaction data collected by the
company suggest that clients remain in the program because
of the convenient, healthy meal options and the personal
accountability required of one-on-one weekly meetings with
a consultant. Published data on retention and attrition in
weight loss programs are generally based on smaller sample
sizes and shorter follow-up periods.
17–20
Lowe et al.
20
reported an attrition rate of 37% in 985 study participants
assigned to a 4-week Weight Watchers intervention, com-
pared to a 27% attrition in the present study. A strength of
our study is the large sample size of free-living men and
women studied over a 52-week period, which may offer a
realistic view of retention rates among clients who enroll in
commercial weight loss programs.
The National Institutes of Health clinical guidelines for the
treatment of overweight and obesity state that the goal of
weight loss therapy should be to reduce body weight by 10%
from baseline with a weight loss ranging from
1
2
to 2
pounds per week over a 6-month period.
1
In our study,
17.8% of the clients lost more than 10% of their baseline
weight, whereas 26.5% lost between 5 and 10% of their
baseline weight. Data from the Diabetes Prevention Program
demonstrate that a 7% weight loss, in addition to an increase
in physical activity and other dietary changes, results in a
58% reduction in risk of developing diabetes.
2
Approxi-
mately, 49% of participants in the Diabetes Prevention
Program achieved the recommended 7% weight reduction
after 24 weeks of the carefully controlled and intensive
intervention.
21
In comparison, clients in our study who
dropped out of the program between weeks 14 and 26 lost
7.3% of their baseline weight, which is an amount that
should provide important health benefits, whereas those
who remained in the study beyond 26 weeks lost signifi-
cantly more weight. Additionally, highly motivated clients
who attended at least 11 consultations by week 13 had a
mean weight loss of over 8% of baseline weight and women
and men who demonstrated a high level of commitment to
the program at 26 weeks lost more than 12% of baseline
weight.
The findings in the present study are consistent with
results from other studies of commercial weight loss
programs and suggest that this program can be an effective
weight loss tool for individuals who remain in the program
for at least 14 weeks. These clients lost more than 7% of their
baseline weight at an estimated cost of $400 through 14
weeks, including enrollment costs and additional food costs
that are above typical weekly food expenditures. Published
results from the Weight Watchers program show weight loss
ranging from 1.9 kg at 4 weeks
20
to 5.0 kg at 1 year.
22
These
results may differ owing to the number of participants, the
length of follow-up and differences in the population.
Investigators studying the Take Off Pounds Sensibly (TOPS)
program reported a weight loss of 14.2 pounds (6.5 kg) in 560
participants at 1 year.
23
Clients in the current study who
remained active at 52 weeks lost about 12.6 kg, although this
represents only 6.6% of the study population.
The study has limitations that may hinder the interpret-
ability of the data. The high attrition rate observed in the
study makes it difficult to determine the effectiveness of the
program. Clearly, clients who remain in the program
experience clinically significant weight loss, but because
the reasons for dropout are unknown it is difficult to describe
differences between those who dropped out and those who
remained active in the program. Also, we are unable to
determine which aspects of the program (i.e., one-on-one
Table 3 Mean weight loss for the 13-, 26- and 52-week cohorts women
13-week cohort 26-week cohort 52-week cohort
N ¼ 14 730 N ¼ 5167 N ¼ 1471
Mean7s.d. Mean7s.d. Mean7s.d.
Baseline weight (kg) 90.07719.76 92.93720.11 96.48721.43
Follow-up weight (kg) 82.58718.41 81.12717.73 80.93717.37
Weight loss at follow-up (kg) 7.4973.38 11.8175.75 15.5679.37
Percent weight loss (%) 8.3173.25 12.5775.09 15.6177.54
Table 4 Mean weight loss for the 13-, 26- and 52-week cohorts men
13-week cohort 26-week cohort 52-week cohort
N ¼ 1204 N ¼ 441 N ¼ 140
Mean7s.d. Mean7s.d. Mean7s.d.
Baseline weight (kg) 114.43722.29 118.47723.53 123.12725.08
Follow-up weight (kg) 104.29720.69 103.58720.48 106.34721.07
Weight loss at follow-up (kg) 10.1474.64 14.8977.90 16.77710.50
Percent weight loss (%) 8.8473.55 12.3975.41 13.2576.73
Retention in a commercial weight loss program
CE Finley et al
5
International Journal of Obesity
consultations, the structured diet, lifestyle counseling and/or
physical activity) are most effective in producing weight loss.
We do not have access to demographic data on a large
percentage of the population and, therefore, are limited in
the types of analyses we can perform. Future data collection
efforts should follow a standardized protocol and include a
complete ascertainment of baseline characteristics and
demographic data in addition to starting weight, such as
height, sex, marital status, income level, occupation and a
basic medical history. The addition of these data would allow
for better characterization of the clients who join commer-
cial weight loss programs and better understanding of the
factors that influence success in the program. Additional
baseline and demographic data would also enable more
accurate comparisons of clients who enroll in different
commercial weight loss programs. Finally, more complete
data on reasons for dropping out or for remaining in the
program would be beneficial.
Although the time period of the study is adequate to
describe the weight loss experience of clients in the program,
lack of data on weight loss maintenance is a limitation of the
study. In a previously published study, Wolfe
24
found that
82% of 267 Jenny Craig clients interviewed in a phone
survey remained within 10% of their post-treatment weight
after a mean follow-up of 56.8 weeks. Weight Watchers
reported that 19.4% of 1002 successful participants who
met their goal weight during the program were still within
5 pounds of their goal weight 5 years later.
25
Among 192
participants in the OPTIFAST program, 57% of participants
had maintained 5% or more of their weight loss after 3 years
of follow-up.
26
Although results from the current study are
promising, additional follow-up studies on a large cohort of
clients who have completed the program would provide
information on the program’s ability to help clients main-
tain their initial weight loss.
The data presented here can be used by health-care
professionals and individuals to characterize the average
retention and success rates experienced by clients in the
program. This information may be useful in decision making
regarding how to select a weight management approach. In
comparison to more cost-prohibitive weight loss options
such as hospital-based or medically supervised programs,
commercial weight loss programs provide easily accessible
options for individuals seeking to lose weight while provid-
ing strategies to develop a balanced lifestyle that incorpo-
rates healthy eating and physical activity.
Acknowledgements
We thank Andy Belden of Fulcrum Analytics for providing
the data for the study. We also thank Melba Morrow for her
editorial assistance in preparing the manuscript. This study
was supported by an unrestricted research grant from Jenny
Craig, Incorporated to The Cooper Institute.
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... This magnitude of weight loss was consistent with similar programs [17,19] and greater than that reported for some other web-based commercial programs [10]. However, it was less than that of commercial programs that use a more intensive, one-to-one consultation model [28]. ...
... Achieving sufficient engagement and user retention is a challenge. For commercial weight loss programs, high attrition rates of up to 70% are common [28,45], and nonusage attrition is also high on web-based weight loss programs [46]. It is important to look at both program attrition and attrition in terms of technology usage because it is possible that people stop using the platform features before they formally drop out [46]. ...
... Platform usage could be thought of as the equivalent of treatment dose in medical studies, and so, while the optimal dose for web-based interventions is unclear, strategies to improve engagement need to be determined. Engagement and retention on a program might be related to user characteristics such as starting weight, as people who are heavier have more weight to lose to reach their weight loss goal and therefore are willing to stay on a program for longer [28]. In this study, starters and stayers had a similar starting BMI, but stayers might have been more intrinsically motivated to adhere to the program and achieve weight loss. ...
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Background Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss. Objective This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years. Methods Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: “stayers” were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while “starters” began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss. ResultsData were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P
... This led to a longer than anticipated recruitment phase so that sufficient number of participants could still complete the study to allow 85% probability of detecting a weight-loss at a 0.05 significance level. Of note, as high as 58% dropout by 13th week into a well-known commercial weight-loss program has been previously reported by other researchers [29]. This experience is similar to another study reporting that men are less likely than women to participate in retail weight-loss programs [30]. ...
... This led to a longer than anticipated recruitment phase so that sufficient number of participants could still complete the study to allow 85% probability of detecting a weight-loss at a 0.05 significance level. Of note, as high as 58% dropout by 13th week into a well-known commercial weight-loss program has been previously reported by other researchers [29]. ...
... Adherence of participants is one of the many factors that may contribute to the impact of a program on community health and fitness. A low initial weight-loss may reduce motivation to adhere in low-responders and can lead to up to 27% reported dropout rate by end of first four weeks [29,66]. The observed extent of variability in weight-loss response in as many as half of our participants even after 12 weeks was striking from that context. ...
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Retail programs offer popular weight-loss options amid the ongoing obesity crisis. However, research on weight-loss outcomes within such programs is limited. This prospective-cohort observational study enrolled 58 men and women between ages 20 and 72 years from a retail program to assess the influence of client features on energy-restriction induced weight-loss response. DESeq2 in R-studio, a linear regression model adjusting for significantly correlating covariates, and Wilcoxon signed-rank and Kruskal–Wallis for within- and between-group differences, respectively, were used for data analyses. An average 10% (~10 kg) reduction in baseline-weight along with lower total-, android-, gynoid-, and android:gynoid-fat were observed at Week 12 (all, p < 0.05). Fifty percent of participants experienced a higher response, losing an average of 14.5 kg compared to 5.9 kg in the remaining low-response group (p < 0.0001). Hemoglobin-A1C (p = 0.005) and heart rate (p = 0.079) reduced in the high-response group only. Fat mass and A1C correlated when individuals had high android:gynoid fat (r = 0.55, p = 0.008). Gut-microbial β-diversity was associated with BMI, body fat%, and android-fat (all, p < 0.05). Microbiota of the high-response group had a higher baseline OTU-richness (p = 0.02) as well as differential abundance and/or associations with B. eggerthi, A. muciniphila, Turicibacter, Prevotella, and Christensenella (all, p/padj < 0.005). These results show that intestinal microbiota as well as sex and body composition differences may contribute to variable weight-loss response. This highlights the importance of various client features in the context of real-world weight control efforts.
... It is known that individuals who prematurely terminate weight loss interventions do not attain the required skills and strategies to effectively overcome barriers to lifestyle change. This impacts long term weight management, with intervention completion positively correlated with weight loss [127]. Other health implications include a reduced quality of life (physical, mental, and social wellbeing), increased loss of income due to work absenteeism [128][129][130], and an increased risk of obesityassociated disease [127,131]. ...
... This impacts long term weight management, with intervention completion positively correlated with weight loss [127]. Other health implications include a reduced quality of life (physical, mental, and social wellbeing), increased loss of income due to work absenteeism [128][129][130], and an increased risk of obesityassociated disease [127,131]. ...
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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting up to 13 % of women. Lifestyle interventions are first-line treatments, however attrition in women with PCOS is high. This review summarises current evidence on barriers to lifestyle management in PCOS and suggested strategies for overcoming these challenges, mapped to the Capability, Opportunity, Motivation and Behaviour model. Physical capability for lifestyle changes may be impacted by altered gut hormone regulation and energy expenditure in PCOS. This may contribute to difficulties with weight management. The higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances are further barriers. Psychological capability may be reduced due psychological symptoms and lack of critical health literacy. Women with PCOS face similar challenges in terms of Opportunity to make lifestyle changes as other women of reproductive age. However, these are complicated by features more common in PCOS including body dissatisfaction. Motivation to adopt healthy lifestyles may be impacted by suboptimal risk perception and intrinsic motivation. To address these barriers, screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea should be undertaken as per international evidence-based guidelines. A weight-neutral approach may be appropriate with disordered eating. Building capability among health professionals to better partner with women with PCOS on their management is essential in addressing health literacy gaps. Behavioural strategies that target risk perception and build intrinsic motivation should be utilised. More research is required to understand optimal self-management strategies, risk perception, energy homeostasis and overcoming attrition in women with PCOS.
... Dieting (limiting or changing the intake of food to lose or maintain weight) and physical activity are frequently promoted as ways to lose weight or prevent additional weight gain. These attempts are frequently unsuccessful, which may be due to a lack of adherence to the weight loss program undertaken [6,7]. However, it is not yet clear what motivates individuals to follow planned weight loss activities. ...
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Understanding food choice is critical to be able to address the rise in obesity rates around the globe. In this paper, we examine the relationship between measured (BMI, using self-reported height and weight) and perceived weight status with the number of calories ordered in a controlled online food choice exercise. A total of 1044 participants completed an online food choice exercise in which they selected ingredients for a sandwich from five categories: meat/protein, cheese, spread/dressing, bread, and vegetables. We examine the number of calories ordered by participants and use linear regression to study the relationship of BMI category relative to self-reported perceived weight status with calories ordered. As a comparison to previous literature, we also examine the relationship between relative weight status and self-reported dieting behavior using logistic regression. We find that participants perceiving themselves to have a higher BMI than their BMI calculated using height and weight ordered significantly fewer calories and were more likely to report dieting than participants who perceived themselves to have a lower BMI than their calculated BMI. The relationship between perceived weight status and measured weight status explains behavior in a food choice task. Understanding how people perceive their weight may help design effective health messages.
... First, unlike interventions that have a set time period from the start, participants could choose how long they wanted to use the program. In addition, retention can drop drastically over time, particularly when considering long-term weight loss; one study found that retention in a commercial weight loss program was more than 70% at 4 weeks but 6.6% at one year [76]. The survey response rate (30%) is also comparable to those found in the survey methodology literature for online surveys (e.g., 35%; [77]). ...
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Little is known about nutritional factors during weight loss on digital commercial weight loss programs. We examined how nutritional factors relate to weight loss for individuals after 4 and 18 months on a mobile commercial program with a food categorization system based on energy density (Noom). This is a two-part (retrospective and cross-sectional) cohort study. Two time points were used for analysis: 4 months and 18 months. For 4-month analyses, current Noom users who met inclusion criteria (n = 9880) were split into 5% or more body weight loss and stable weight loss (0 ± 1%) groups. Individuals who fell into one of these groups were analyzed at 4 months (n = 3261). For 18-month analyses, individuals from 4-month analyses who were still on Noom 18 months later were invited to take a one-time survey (n = 803). At 18 months 148 participants were analyzed. Noom has a system categorizing foods as low-, medium-, and high-energy-dense. Measures were self-reported proportions of low-, medium-, and high-energy-dense foods, and self-reported nutritional factors (fruit and vegetable intake, dietary quality, nutrition knowledge, and food choice). Nutritional factors were derived from validated survey measures, and food choice from a novel validated computerized task in which participants chose a food they would want to eat right now. ANOVAs compared participants with 5% or more body weight loss and participants with stable weight (0 ± 1%) at 4 months on energy density proportions. Analyses at 18 months compared nutritional factors across participants with >10% (high weight loss), 5–10% (moderate weight loss), and less than 5% body weight loss (low weight loss), and then assessed associations between nutritional factors and weight loss. Individuals with greater weight loss reported consuming higher proportions of low-energy-dense foods and lower proportions of high-energy-dense foods than individuals with less weight loss at 4 months and 18 months (all ps < 0.02). Individuals with greater weight loss had higher fruit and vegetable intake (p = 0.03), dietary quality (p = 0.02), nutrition knowledge (p < 0.001), and healthier food choice (p = 0.003) at 18 months. Only nutrition knowledge and food choice were associated with weight loss at 18 months (B = −19.44, 95% CI: −33.19 to −5.69, p = 0.006; B = −5.49, 95% CI: −8.87 to −2.11, p = 0.002, respectively). Our results highlight the potential influence of nutrition knowledge and food choice in weight loss on a self-managed commercial program. We also found for the first time that in-the-moment inclination towards food even when just depicted is associated with long-term weight loss.
... Participation in a customized weight loss program that includes a controlled diet, increased physical activity, motivational interviewing, and weight loss counseling is known to positively influence weight loss and cardiometabolic outcomes 28,[35][36][37][38] . The overall weight loss in our study of 7-9% of baseline body weight was much larger than that observed in previous clinical trials of TRE that report modest body weight reductions of 1-3% with TRE compared with ad libitum intake 5,19,20,23,24,27 . ...
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Background Time restricted eating (TRE) is an emerging dietary intervention for weight loss that is hypothesized to reinforce the metabolic benefits of nightly fasting/ketosis. This pilot study investigated the effectiveness of a daily 14-h metabolic fast (14:10 TRE beginning after dinner, a “fasting snack” at hour 12, and ending with breakfast 14 h later) combined with a commercial weight management program on body weight and fasting blood glucose (FBG) in individuals with obesity. We also investigated the effect of the low-calorie, high-fat, low-carbohydrate, and low-protein “fasting snack” on blood glucose. Methods This 8-week, randomized, controlled, clinical trial included men and women (BMI ≥ 30 kg/m ² ) between June and October 2020. Study procedures were conducted remotely. Participants were randomized to 14:10 or 12-h TRE (12:12, active comparator) and prescribed a diet (controlled for calories and macronutrient composition) and exercise program that included weekly customized counseling and support. The primary outcome was change from baseline in body weight in the 14:10 group. Results Of the 78 randomized participants, 60 ( n = 30/group) completed 8 weeks. The LS mean change from baseline in weight in the 14:10 group was −8.5% (95% CI −9.6 to −7.4; P < 0.001) and −7.1% (−8.3 to −5.8; P < 0.001) in the 12:12 group (between group difference −1.4%; −2.7 to −0.2; P < 0.05). There was a statistically significant LS mean change from baseline to week 8 in FBG in the 14:10 group of −7.6 mg/dl (95% CI −15.1 to −0.1; P < 0.05) but not in the 12:12 group (−3.1 mg/dl, −10.0 to 3.7; P = NS). Both interventions resulted in a larger reduction in FBG in participants with elevated FBG (≥100 mg/dl) at baseline (both P < 0.05). Conclusions In participants with obesity who completed 8 weeks of the 14:10 TRE schedule combined with a commercial weight loss program, there was statistically significant and clinically meaningful weight loss and improvements in FBG.
... For example, research shows that less than expected weight-loss during the initial weeks may lower the motivation to adhere and can lead to large dropouts. The studies also report cost, scheduling conflicts, tiring of the limited food choices, unrelated health issues, or lack of consistent/sustained results as other potential reasons for discontinuing weight-loss interventions [41][42][43]. ...
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Overweight and obesity are global health problems that contribute to the rising prevalence of non-communicable diseases, such as type 2 diabetes, heart disease, and certain cancers. The World Health Organization recognizes obesity as a primarily diet-induced, preventable condition, yet losing weight or keeping weight loss permanent is a universal challenge. In the U.S., formal dietary guidelines have existed since 1980. Over the same time-period, the incidence of obesity has skyrocketed. Here, we present our perspective on why current dietary guidelines are not always supported by a robust body of scientific data and emphasize the critical need for accelerated nutrition research funding. A clear understanding of the interaction of dietary patterns with system-level biological changes in a precise, response-specific manner can help inform evidence-based nutrition education, policy, and practice.
... 1.1% (SD 1.6%) body weight. Unfortunately, only 6.6% of original enrollees were still in the program by week 52, with a full 27% dropping out within the first month [8]. Overall, long-term weight loss is especially difficult often because those seeking to lose weight discontinue their efforts. ...
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Purpose of Review Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs. Recent Findings Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats. Summary Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.
Article
Obesity is a significant contributor to the development of chronic diseases, some of which can be prevented or reversed by weight loss. However, dietary weight loss programs have shortcomings in the success rate, magnitude, or sustainability of weight loss. The Individualized Diet Improvement Program’s (iDip) objective was to test the feasibility of a novel approach that helps individuals self-select a sustainable diet for weight loss and maintenance instead of providing weight loss products or rigid diet instructions to follow. The iDip study consisted of 22 dietary improvement sessions over 12 months with six months of follow-up. Daily weights were collected, and a chart summarizing progress was provided weekly. Six 24-hour dietary records were collected, and dietary feedback was provided in the form of a protein-fiber plot, in which protein/energy and fiber/energy of foods were plotted two-dimensionally together with a target box specific to weight loss or maintenance. An exit survey was conducted at 12 months. Twelve (nine female, 46.3±3.1 years (mean±SE)) of the initial 14 participants (BMI>28 kg/m ² ) completed all sessions. Mean percent weight loss (n = 12) at six and 12 months was -4.9%±1.1 (p = 0.001) and -5.4%±1.7 (p = 0.007), respectively. Weight loss varied among individuals at 12 months; top and bottom halves (n = 6 each) achieved -9.7%±1.7 (p = 0.0008) and -1.0%±1.4 weight loss, respectively. The 24-hour records showed a significant increase in protein density from baseline to final (4.1g/100kcal±0.3 vs. 5.7g/100kcal±0.5; p = 0.008). Although mean fiber density showed no significant change from the first month (1.3g/100kcal±0.1), the top half had significantly higher fiber/energy intake than the bottom half group. The survey suggested that all participants valued the program and its self-guided diet approach. In conclusion, half of the participants successfully lost >5% and maintained the lost weight for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach.
Article
Context Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Objective This study was designed to evaluate effects of lifestyle modifications and synbiotic supplementation on PCOS. Design A randomized (1:1) double-blind, placebo-controlled trial. Setting Academic hospital. Patients or Other Participants Overweight and obese women with PCOS were identified according to the Rotterdam criteria. Evaluations were performed at baseline and repeated after 3 months of treatment. Intervention Lifestyle modifications in combination with synbiotic supplementation or placebo. Main Outcome Measures Change in BMI and testosterone level. Results In the Placebo Group, a 5% decrease in BMI was accompanied by significant decreases of the waist, hip, and thigh circumferences. The Synbiotic Group experienced an 8% decrease in BMI, which was significantly greater than that in the Control Group (P=0.03) and was accompanied by decreases in the waist, hip, and thigh circumferences. Testosterone did not decrease significantly in the Placebo Group (decrease of 6%), while in the Synbiotic Group it decreased by 32% (P<0.0001). The decrease of testosterone was significantly greater in the Synbiotic Group than in the Placebo Group (P=0.016). Conclusions Synbiotic supplementation potentiated effects of lifestyle modifications on weight loss and led to significant reduction of serum testosterone.
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Orlistat, a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, may promote weight loss and reduce cardiovascular risk factors. To test the hypothesis that orlistat combined with dietary intervention is more effective than placebo plus diet for weight loss and maintenance over 2 years. Randomized, double-blind, placebo-controlled study conducted from October 1992 to October 1995. Obese adults (body mass index [weight in kilograms divided by the square of height in meters], 30-43 kg/m2) evaluated at 18 US research centers. Subjects received placebo plus a controlled-energy diet during a 4-week lead-in. On study day 1, the diet was continued and subjects were randomized to receive placebo 3 times a day or orlistat, 120 mg 3 times a day, for 52 weeks. After 52 weeks, subjects began a weight-maintenance diet, and the placebo group (n = 133) continued to receive placebo and orlistat-treated subjects were rerandomized to receive placebo 3 times a day (n = 138), orlistat, 60 mg (n = 152) or 120 mg (n = 153) 3 times a day, for an additional 52 weeks. Body weight change and changes in blood pressure and serum lipid, glucose, and insulin levels. A total of 1187 subjects entered the protocol, and 892 were randomly assigned on day 1 to double-blind treatment. For intent-to-treat analysis, 223 placebo-treated subjects and 657 orlistat-treated subjects were evaluated. During the first year orlistat-treated subjects lost more weight (mean +/- SEM, 8.76+/-0.37 kg) than placebo-treated subjects (5.81+/-0.67 kg) (P<.001). Subjects treated with orlistat, 120 mg 3 times a day, during year 1 and year 2 regained less weight during year 2 (3.2+/-0.45 kg; 35.2% regain) than those who received orlistat, 60 mg (4.26+/-0.57 kg; 51.3% regain), or placebo (5.63+/-0.42 kg; 63.4% regain) in year 2 (P<.001). Treatment with orlistat, 120 mg 3 times a day, was associated with improvements in fasting low-density lipoprotein cholesterol and insulin levels. Two-year treatment with orlistat plus diet significantly promotes weight loss, lessens weight regain, and improves some obesity-related disease risk factors.
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Objective. —To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
Article
• The management of obesity is increasingly dominated by nonprofessional self-help groups. Little information about the efficacy of these groups is available from independent sources. In a study of 108 women enrolled in a commercial weight reduction program, we found very high attrition rates; 50% of the members dropped out in six weeks and 70% in 12 weeks. Similar attrition rates have been reported in five other programs in three different countries. Very high attrition rates diminish the effectiveness of commercial weight reduction programs, and they suggest caution in the interpretation of data based on weight losses of persons who remain in these programs.(Arch Intern Med 1981;141:426-428)
Article
Objective: To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants: A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence: The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus process: Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion: Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Article
Twenty-one local chapters of a nationwide self-help group for the control of obesity were studied in 1968 and again in 1970. Mean weight loss of individual members in the two surveys was remarkably similar-15.0 and 14.2 lb. Attrition rates were very high—47% at one year and 70% at two. Initial degree of overweight was strongly associated with duration of membership in this program; the more overweight members not only had lower attrition rates, they also lost more weight. Within individual chapters, there was a very large variance in mean weight loss, and chapters did not seem to maintain the same level of effectiveness during the two-year period. Introduction of behavior modification techniques is a possible method of improving the group's performance.
Article
T ODAY, OBESITY HAS REACHED EN-demic proportions 1 and the widespread lack of clinical suc-cess 2 calls for effective treat-ment of this chronic disorder. Thera-peutic intervention prevents the serious and cost-intensive sequelae of this con-dition. 3 The reluctance of the medical profession to treat obesity 4 is fortu-nately no longer justified because short-term weight reduction achieved by in-terventions, such as dieting, exercise, and behavior modification programs, can lead to long-term weight loss through the use of effective medicines. 5-8 These drugs are designed to be used as an adjunct to non-medical therapy. 9-11 Obesity can be seen as the underlying condition predispos-ing persons to cardiovascular risk fac-tors. Thus, symptomatic treatment of these risk factors can now be replaced by a causal therapy that addresses obesity itself. The main objective of this phar-macotherapeutic approach is to achieve long-term weight loss, 12 and there is evi-dence that even moderate weight loss of 5% to 10% results in reduced morbid-ity 13 and mortality. 14 Sibutramine hydrochloride enhances satiety, primarily by blocking the reup-take of 2 neurotransmitters, noradrena-line and serotonin. It is also postulated that sibutramine increases the meta-bolic rate by enhancing peripheral nor-adrenaline function via 3-adrenocep-tors leading to an increase in energy expenditure. 15 So far, approximately 8000 patients have taken sibutramine in clini-cal studies. Its effectiveness in reducing weight and achieving weight mainte-nance already has been shown in sev-eral randomized, double-blind stud-ies. 16,17 The aim of this randomized study was to show equivalent weight reduc-tion in an obese population using 2 thera- Context Treatment of obesity requires long-term therapy, which can be hampered by difficulties in achieving patient compliance. The effectiveness of sibutramine hy-drochloride in treating obesity has been shown in randomized controlled trials. Objective To compare the effectiveness of 2 distinct sibutramine regimens with each other and with placebo for weight reduction among obese persons. Design Randomized, double-blind, parallel-group placebo-controlled trial from April 1997 to September 1998. Setting One hundred eight private practices and 3 outpatient departments of uni-versity hospitals in Germany. Patients A total of 1102 obese adults (body mass index, 30-40 kg/m 2) entered the 4-week open-label run-in period with 15 mg/d of sibutramine, 1001 of whom had weight loss of at least 2% or 2 kg were randomized into the 44-week randomized treatment period. Interventions Patients were randomly assigned to receive 15 mg/d of sibutramine continuously throughout weeks 1-48 (n = 405); 15 mg/d of sibutramine intermit-tently during weeks 1-12, 19-30, and 37-48, with placebo during all other weeks (n = 395); or placebo for weeks 5-48 (n = 201).
Article
About 97 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. The aim of this guideline is to provide useful advice on how to achieve weight reduction and maintenance of a lower body weight. It is also important to note that prevention of further weight gain can be a goal for some patients. Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort. Assessment of Weight and Body Fat Two measures important for assessing overweight and total body fat content are; determining body mass index (BMI) and measuring waist circumference. 1. Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in body weight. Measurements of body weight alone can be used to determine efficacy of weight loss therapy. BMI is calculated as weight (kg)/height squared (m 2). To estimate BMI using pounds and inches, use: [weight (pounds)/height (inches) 2 ] x 703. Weight classifications by BMI, selected for use in this report, are shown in the table below. • Pregnant women who, on the basis of their pre-pregnant weight, would be classified as obese may encounter certain obstetrical risks. However, the inappropriateness of weight reduction during pregnancy is well recognized (Thomas, 1995). Hence, this guideline specifically excludes pregnant women. Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997.