Studies published in the New England Journal of Medicine Monday and Tuesday compare the effectiveness of various weight-loss interventions among obese adults.
In one, 390 obese adults received one of three kinds of intervention: “usual care,” in which quarterly visits to a primary-care-physician included education about weight management; “brief lifestyle counseling,” which included those doctor visits plus monthly sessions with lifestyle coaches who offered brief instruction about behavioral weight control, or “enhanced brief lifestyle counseling,” which added meal replacements or weight-loss medication to the “brief lifestyle counseling” protocol.
At 24 months, the mean weight loss among those in the usual care group was 3.73 pounds, 6.38 pounds among the brief lifestyle counseling group and 10.12 pounds in the enhanced brief lifestyle counseling group. In the usual care group, 21.5 percent lost at least 5 percent of their initial weight; 26 percent of the brief lifestyle counseling group and 34.9 percent of the enhanced brief lifestyle counseling group did so, which makes a pretty good case for meal replacements and weight-loss medications.
In the other study, 415 obese patients (mean age 54 years) were offered support for their weight-loss efforts either remotely (via phone, a Web site and e-mail) or in person during group and individual sessions. The second group received the remote interventions as well. Participants in a control group “self directed” their weight-loss efforts. At 24 months, those in the remote-support-only group had lost a mean of 10.12 pounds; those in the remote-plus-in-person support group lost a mean of 11.22 pounds; and those in the control group lost a mean of 1.76 pounds. While 38.2 percent of the remote-only group lost 5 percent or more of their starting weight, 41.4 percent of those in the remote-plus-in-person group did so; only 18.8 percent of the control group achieved that 5-percent weight loss, a widely accepted benchmark at which health benefits of weight loss start to kick in. In short, those receiving only remote support lost nearly as much as those also receiving in-person support.
An editorial accompanying the studies notes that remote interventions could help overcome barriers, logistical and perhaps psychological, that prevent some people from taking advantage of weight-loss support programs. They also suggest that for at least some percentage of the obese adult population, physician-directed weight loss can be effective. But the editorial also notes that physician oversight of weight-loss efforts, meal replacements and weight-loss medications cost money, and it questions whether patients, or insurance companies, will be willing to pay.
Research published last week on bmj.com found that Weight Watchers trumped physician-guided weight-loss programs. That study also raised the question of who will, or should, pick up the tab.