Commercial Weight-loss Products and Programs
(Weight maintenance, Overweight, Obesity and Severe Obesity)

Non-clinical methods can take many forms. They include, but are not limited to, weight-loss chains, such as Weight Watchers, health coaches, diet books, Web sites such as www.eDiets.com or www.SparkPeople.com, over-the-counter (OTC) medications such as alli®, body monitoring devices such as BodyMedia® or bodybugg®, meal replacement items, meal replacement systems programs such as Jenny Craig and Nutrisystem, and support groups. Some non-clinical weight management methods may require you to use the program’s foods or supplements, and there may be fees for professional services.

The range of weight-loss methods available is wide, and the claims they make are equally as wide. Some of the claims are reasonable (“Lose 1-2 pounds per week”) and some are outlandish (“A bikini body in 30 days!”). It is important to remember that not all methods and claims are reviewed by the Food and Drug Administration (FDA), who ensure the safety and effectiveness of medical devices and prescription and OTC weight-loss medications but not weight-loss supplements or books.

A good rule of thumb is if a product or claim sounds too good to be true, it probably is. A reasonable goal is to lose about a pound or two a week. For most people, that means consuming 500 calories less per day, exercising more and eating more nutritious foods. If a weight-loss method claims to help you lose significantly more than one to two pounds a week, steer clear of it.

Diet Books

It is not uncommon for people to turn to popular diet books when seeking to lose or manage weight. Diet books have been around since at least the mid-19th century, so clearly there is an enduring market for those seeking to improve their weight and health in this way.

Marketdata Enterprises reported that in 2009-2010, 80 percent of dieters were using a self-directed program such as a book or Web site, so if this is what you are choosing, you are definitely not alone.

How do they work?
One of the primary benefits of following a weight-loss program from a book is the cost. Most books are relatively inexpensive to purchase or can be obtained for free from a local library. Most do not require you to invest in packaged foods or other tools. You are usually looking at some form of dietary change and portion control, often paired with exercise and self-monitoring. For most people, the cost to follow the diet will be similar to what they already spend on the food they eat now.

Weight-loss: Depending on your ability to follow the program, you may experience a one to two pound weight-loss per week.

Concerns: The cons of using a diet book as your means of weight-loss include verifying the safety and efficacy of the plan. Authors trying to sell books are often biased, as they profit from book sales, and they may not have the qualifications necessary to provide health advice. With the huge variety of plans available, the simple truth is that some diet books are good and others are not, and if you are not an expert, you may have a hard time choosing what ones are acceptable.

In addition, using a book as your diet plan usually means you’re attempting to make a change on your own. For many people, especially those with health challenges like diabetes or with larger amounts of weight to lose, attempting to make the change on your own may reduce the chance of success and/or increase the risk of having complications. For this reason, it is always good to let a healthcare professional know if you are embarking on a weight-loss plan and to discuss the pros and cons with them.

Examples of popular diet books that advocate weight-loss methods generally deemed by dietitians to be safe and reasonably effective include:

      • The South Beach Diet by Dr. Arthur Agatston
      • The Atkins Diet by Dr. Robert Atkins
      • The Volumetrics Eating Plan by Barbara Rolls
      • Eat This, Not Thatby David Zinczenko with Matt Goulding
Online/Web-based Diet Programs

Like diet books, web-based diet programs come in many shapes and sizes. Some are free, some charge a fee. Some are nutritionally sound, some are not.

How do they work?
A number of these programs are online versions of in-person programs (www.weightwatchers.com) or books (www.southbeachdiet.com or www.jillianmichaels.com) while others, such as www.eDiets.com or www.SparkPeople.com, may allow users to select from a variety of programs to suit their needs. Most online sites offer simple tools like recipes, meal ideas, eating out tips, workouts and progress tracking. Forums or chat-style discussions, which allow users to connect with one another for tips and ideas, are commonly found at these sites. Many sites offer “add-on” services (usually for a fee) such as a personal counselor, more in-depth tools or prepared meals. Many now also have “apps” that can be loaded onto a computer, tablet or smartphone to help with self-monitoring, reminders, shopping and more.

Weight-loss: Depending on your ability to follow the program, you may experience a one to two pound weight-loss per week.

Concerns: Like diet books, a self-directed web-based diet program may suit your needs if you are looking for flexible tools to help you manage your weight. In addition, both diet books and web-based diet programs allow people to use regular grocery store food, which most people prefer. As the quality of the eating plans vary both in their nutrition and safety, especially for those with certain medical conditions, it is best to discuss the plan you have chosen to follow with a healthcare professional before you start.

Dietary Supplements

Perhaps the most complex set of products targeting individuals seeking to lose weight are dietary supplements. While manufacturing of dietary supplements is regulated by the FDA, companies marketing products in this category do not have to seek pre-market approval. This means that products do not have to undergo studies proving to the FDA they are safe or effective before being sold.

How do they work?
While dietary supplements may contain ingredients that claim to support weight-loss or improved body composition, one needs to examine the action of each ingredient individually, as well as in relation to the other ingredients and to other medications one may be taking in order to judge the supplement’s potential effectiveness. If you are considering using a dietary supplement for weight-loss, it is best to take a list of its ingredients to a healthcare professional or pharmacist to determine if the product is right for you. Further guidance from the Federal Trade Commission (FTC) on this topic can be found here: www.ftc.gov/bcp/edu/pubs/consumer/health/hea03.shtm.

Weight-loss: Weight-loss results from dietary supplements is often difficult to measure as there are many supplements available that may or may not work in conjunction with another weight-loss strategy, such as exercise or changes in dietary restrictions. As with any weight-loss program, a one to two pound per week weight-loss is recommended for safety and health.

Concerns: While companies are supposed to follow FDA and FTC guidance for advertising and claims, it is clear that many do not. Thus, it is not uncommon to see ads for dietary supplements claiming that you can lose weight rapidly without changing the way you eat, or without lifestyle changes. The influence of celebrity promoters can contribute to the perception that a product may offer a miracle cure for obesity. In fact, good scientific evidence that they work is generally lacking.

Body Monitoring

A new method of controlling one’s weight has grown in popularity in the last few years – body monitoring. There are many different devices available and all come with a host of options, such as online tools, smartphone apps and more.

How do they work?
Body monitoring involves wearing a device, usually an armband or a gadget carried in one’s pocket, that tracks a sufficient number of bodily processes (skin temperature, movement, acceleration, heat flux and more) to be able to accurately report how many calories the wearer has burned. Combined with a detailed record of what one eats (that the wearer creates by entering items into an online log), it’s possible for someone to look at their calorie balance (calories in vs. calories out) and get a detailed understanding of why they are gaining or losing weight. This in turn allows them to make adjustments accordingly. Body monitors are significantly more accurate than pedometers, which only measure steps taken and not the intensity of activities.

Weight-loss: Body monitoring devices alone will not result in weight-loss. These devices are meant to be used along with a weight-loss option.

Concerns: Body monitors cost about $100 to $250 and require an online access fee of around $7-10 per month. The benefit of using a body monitor is that a wearer will get a good understanding of which of their activities burn calories best. The downside is that food logging can become tiring, and the ability of a body monitor to accurately calculate calories depends entirely on how well the wearer tracks their food consumption. In addition, not everyone wants to wear an armband or carry a device at all times.

Over-the-Counter Drugs

Currently alli® (orlistat) is the only approved over-the counter drug for weight-loss, which means the FDA has reviewed the product and found it to be safe and effective when used as directed.

How does it work?
The product alli® is a lower potency of the prescription drug Xenical® (orlistat). It is the only FDA-approved weight-loss medication that is available over-the-counter and available at a higher dose with a prescription. It is a capsule that is usually taken three times per day before a meal that contains dietary fat. It works by decreasing the amount of fat your body absorbs. This means that only 2/3 of the calories that you take in from fat will be absorbed. The other 1/3 of the calories gets carried away in the digestion tract as stool. The company that makes this drug (GlaxoSmithKline Consumer Healthcare) also offers a Web site with education and support tools for users at www.myalli.com.

Weight-loss: The average weight-loss is about 3-4 percent of your weight after one-year. In a person who weighs 200 pounds, this would mean eight pounds of weight-loss.

Concerns: It does not work well for people who are already on a low-fat diet since their calories from fat are already low.

Individuals using alli® on a regular basis should take a daily multivitamin as there is potential for deficiency in some vitamins. One of the advantages of alli® is that its side effects are limited to the gastrointestinal system. Common side effects are cramps, gas, stool leakage, oily spotting and gas with discharge that improve with a lower fat diet.

Commercial Weight-loss Centers/Programs

Utilizing a commercial weight-loss center or program is one of the most popular options for someone affected by obesity. Centers often provide various resources such as pre-packaged meals, support and more. Centers usually offer a 1,000 to 1,500 calorie-per-day diet plan which can provide quick weight-loss results; however, as weight-loss slows down, it is easy for people to get frustrated and discouraged.

Because commercial plans vary greatly, the FTC recommends asking the following questions before engaging in a program:

      • How much, on average, do clients regain long-term?
      • What is your maintenance and follow-up program?
      • What rate of weight-loss does your program aim for?
      • Does the program emphasize balanced food choices and exercise?
      • Are you required to buy specially formulated foods or supplements?
      • What are the costs of membership, weekly fees, brand food, supplements and counseling?
      • What are the credentials of those running the program?
      • What are the health risks?

In this section, we will examine some of the most popular commercial weight-loss centers by separating them into two different categories: “Meal Replacement” and “Non-meal Replacement.” Let’s take a brief moment to examine these two categories:

Meal Replacement

Meal replacement through pre-packaged meals can be appealing because of the convenience and ease of choice they offer; however, when meals are pre-packaged, participants may not learn the basics of nutrition and healthy eating. In such a case, weight maintenance becomes difficult and people quickly regain the weight they’ve lost. Pre-packaged meals may also be expensive (this claim is dependent on the normal weekly food cost an individual would incur).

Liquid meal replacement plans, if used for too long, may be harmful because they can cause nutritional deficiencies. Also, people often have trouble sticking with these programs for continued weight-loss because of the difficulty of maintaining a “normal” lifestyle. Unfortunately, when participants have not learned the principles of healthy eating and portion control, they often resume prior eating patterns.

Non-meal Replacement

Some centers do not utilize meal replacement as part of their program. Their main goal is to teach you how to nutritiously feed your body and make smart food choices. While this is helpful long term, many individuals find it hard to adjust to at first.

Overall, a safe and effective commercial program will offer educational materials that have been reviewed by a licensed healthcare professional. These materials will include information on healthy eating plans, exercise and behavior therapy.

Commercial Weight-loss Programs That Use Meal Replacements

Nutrisystem
Nutrisystem, founded in 1972, offers pre-packaged meals delivered to your home, and dietary counseling. Years ago Nutrisystem was a storefront business but for more than a decade the company has offered an online & telephonic weight-loss program, complete with counseling and menu planning.

Nutrisystem features portion-controlled foods and structured meal plans that are both high in protein and low in glycemic index (GI). Low-GI means that the foods do not cause your blood sugar to rise sharply. For people with diabetes, a low-GI diet can help keep blood glucose in control. Nutrisystem’s program for people with or at risk of type 2 diabetes, Nutrisystem D, has been proven effective in three clinical trials to date.

How does it work?
Nutrisystem plans, tailored for men and women, encourage you to consume three meals and two or three snacks per day. The plans offer about 130 different pre-packaged foods to choose from. Foods are home-delivered, typically in shipments every four weeks, after you place an order online or over-the-phone. You have to purchase additional fruits, vegetables and dairy products on your own. These are grouped into three categories: SmartCarbs (nutrient-rich, high-fiber carbohydrates), PowerFuels (lean proteins and healthy fats) and Vegetables (non-starchy ones, which can be eaten freely). A meal planner explains how and when to add these foods into your diet. The program has an active online community, including discussion boards and dietitian-led chats. Counseling, for those who want it, is available and included with most Nutrisystem programs.

Weight-loss: With the recommended fruits, vegetables and dairy products, this diet plan can be considered well-balanced. Participants following the plan’s diet and exercise recommendations should see about a one to two pound per week weight-loss. Research on Nutrisystem customers showed an average weight-loss of 18 pounds at three months and 27 pounds at six months.

Concerns: Evidence is mixed for Nutrisystem’s claim that low-GI foods are better for weight-loss. Some research finds a small weight-loss advantage for low-GI diets over high-GI ones, but other studies find no difference. Whether or not a low-GI diet is “better” for weight-loss, Nutrisystem’s meal programs are low in calories and are designed to meet national nutrition guidelines; so, this should be a healthy way to lose weight.

Another concern is that participants using pre-packaged meals do not necessarily learn good nutrition, which makes maintaining weight-loss difficult once they return to buying food on their own. In 2011, Nutrisystem began to address this with “transition and maintenance” plans that reduce the number of pre-packaged foods and increase the focus on preparing and choosing healthy meals in the proper portions. Counselors are also available throughout the program and during transition and maintenance to educate about good eating habits during program and on your own.

The final concern is the cost of the food. Membership is free and there is no long-term contract; the Nutrisystem foods cost about $230-$350 for a 28-day package. This does not include the additional fruits, vegetables and other food that you must purchase on your own. Although Nutrisystem claims that the full cost of eating while on the program is about 15 to 40 percent less than what the average American spends on food, some consumers would rather buy food week-to-week. Some employers and health plans subsidize or reimburse program costs.

Jenny Craig
The Jenny Craig program was founded more than 15 years ago and has 800 centers nationwide. It offers frozen or pre-packaged prepared meals to help with portion management and calorie control. Jenny Craig offers weekly one-on-one nutritional and motivational counseling. It was developed by registered dietitians and psychologists and focuses on lifestyle changes.

How does it work?
A typical Jenny Craig program consists of three meals and three snacks per day, which are calorie-controlled based on your height and weight. Sixty percent of the day’s food comes from carbohydrates, 20 percent from protein and 20 percent from fat.

You are required to purchase main dishes from Jenny Craig for the first phase, which is defined as the first half of your total weight-loss goal. You work with your diet counselor to incorporate other foods, such as fruits, vegetables, dairy and grains, into your meals.

After the initial phase, you transition entirely to foods you purchase yourself; however, you are required to keep a food log and work with the diet counselors on making good food choices.

Weight-loss: Overall, the Jenny Craig diet is a well-balanced, reduced-calorie diet in which you can expect to lose about one to two pounds per week. In a research study conducted by Jenny Craig, participants who received the prepackaged food items and program free of charge lost an average of 16 pounds, or 7.9 percent of their initial weight after two years of treatment.

Concerns: There are some concerns with this program. First, the program may not teach the basics of nutrition in the initial phase, which could lead to weight regain in the long run. Also, counselors are not dietitians and, as with many commercial programs, they are encouraged to sell products. Finally, the cost of the program averages about $90-$125 per week. This includes only the entrées and snacks provided by Jenny Craig. You must purchase the additional fruits, vegetables, dairy and grains required from the grocery store.

The program offers fitness tapes and videos for purchase. Participants must also pay membership fees that run from $10 to $40 per month.

Slim-Fast (Available in supermarkets, grocery stores and pharmacies)
Slim-Fast has been around for more than 25 years and offers relatively quick weight-loss by substituting a calorie-controlled, sweet-tasting fortified meal replacement shake or bar for some of your regular meals. The program offers online support that includes weight, diet and exercise charting, chat rooms with online buddies, chat sessions with registered dietitians, a weekly newsletter, exercise programs and meal planning.

How does it work?
The diet plan is centered around two Slim-Fast meal replacements. One meal consists of a “Meal-on-the-Go” shake or bar and the other is a similar shake or bar combined with 200 calories of your favorite healthy foods. The third meal is a “sensible meal” of about 500 calories, with 1/2 of your plate filled with veggies, 1/4 with lean protein (such as chicken without the skin), 1/4 with starch, a salad on the side and fruit for dessert. A snack of 120 calories is also offered during the day. Fruits and vegetables (about 3-5 servings) are encouraged in addition to the meals and snack.

As dieters approach their weight maintenance phase, they can replace the shakes or bars with two additional “sensible meals;” however, Slim-Fast provides little instruction on transitioning from portion-controlled products back to regular foods, an omission which is likely to leave dieters struggling to maintain their weight-loss or relying on Slim-Fast products indefinitely.

Weight-loss: Overall, if followed correctly, the plan does encourage additional fruits and vegetables and it stays at or above 1,200 calories a day, leading to more balanced consumption than traditional liquid diets.

Meal replacement diets such as Slim-Fast are appealing because of their simplicity and convenience. If you plan to use Slim-Fast, you should consider doing so under the supervision of a healthcare professional, who can help teach you how to transition yourself from the shakes and who can monitor for potential complications of a fast weight-loss.

Concerns: The shakes are about $1.40 and the meal replacement bars about $1. The biggest drawback is that dieters may not receive comprehensive information about nutrition, which means that as they transition back to regular foods, which they are likely to do eventually, weight gain may be inevitable. Also, the recommended calorie level may be too low for some dieters.

Commercial Weight-loss Programs That Do Not Use Meal Replacements

Weight Watchers
Weight Watchers was founded in the 1960′s and offers weight-loss guidance and support. The plan emphasizes a well-balanced diet and encourages lifestyle changes and exercise.

How does it work?
Weight Watchers offers two plans, so dieters can pick the one that better fits their lifestyle. The Flex Plan is based on a points system. All food is assigned a certain number of points according to calories, fat and fiber content. Dieters are allowed to consume a certain number of points each day based on their body weight and the number of pounds they want to lose. The Weight Watchers system teaches that all food can potentially be incorporated into a healthy eating plan, as long as the daily point values are not exceeded.

Dieters on Weight Watchers learn to balance their food choices. They can also trade physical activity for more points. A second option, the Core Plan, focuses on healthy foods (whole grains, fruits, vegetables and low-fat protein foods) which users can eat at will, without the need for tracking points.

Weight Watchers offers weigh-ins and weekly meetings, which can be private, online or in groups. In the weekly meetings, dieters receive a lot of encouragement, help, suggestions and strategies. No foods are forbidden, and no foods are required to be purchased.

In addition, most foods, even restaurant foods, already have points assigned to them, which makes keeping track of consumption a lot easier. Weight Watchers encourages dieters to keep a food log, which turns off a lot of dieters, but tracking what you eat has been shown to have a strong positive effect on weight-loss. Weight Watchers counselors also teach the basics of nutrition and healthy lifestyle choices at the weekly meetings, which increases the chances of long-term success.

With Weight Watchers, dieters learn that higher fat and calorie foods can be incorporated into daily consumption but do “cost” more points and therefore must be traded off for less food later in the day or week or increased exercise, in order not to exceed point allowances.

Weight-loss: Overall, Weight Watchers can teach healthy, balanced eating for a one to two pound per week weight-loss. Weight Watchers is most similar to what dietitians would teach (calorie counting and food logging), and most healthcare professionals regard it as a standard against which to measure other commercial programs. In a research study conducted by Weight Watchers in Europe, participants who received the program free of charge lost an average of 11 lbs of their initial weight after one year of treatment.

The cost of a Weight Watchers membership is about $30, and meetings cost about $10-$15 per week, although some discount packages are offered. The online version costs about $20 per month after a $30 membership fee. Support online includes chat rooms, message boards, recipe ideas, meal plans and online journaling.

Concerns: One concern is that while counselors are trained to provide the support and encouragement needed for weight-loss, they are not licensed dietitians. Another concern is that foods that are zero in point value can have as much as 60-80 calories in them. Eating a lot of these zero point value foods throughout the day can slow or stop weight-loss, especially for smaller older women or for people with slower metabolisms.

Evaluate Your Choices

If you are in the market for a commercial weight-loss program, you will find that you are faced with hundreds of choices, many with claims sounding too good to be true. It is important when choosing a commercial program to evaluate them based on what will work for you. As a wise dieter once said, “The best diet is one you can stick with.”

Tips for Evaluating Commercial Weight-loss Programs

Make sure whatever plan you choose:

      • Promotes gradual weight-loss
      • Teaches you how to make permanent lifestyle changes
      • Encourages exercise
      • Does not exclude major food groups
      • Does not make certain foods “bad” or “illegal”
      • Does not make outlandish weight-loss claims

 Next – Physician Supervised Weight-Loss



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