What is Obesity Treatment?

Commercial Weight-loss

weight-loss medicationThis section reviews some of the most popular types of commercial weight-loss products and programs.
Non-clinical methods can take many forms. They include, but are not limited to, widely available weight management programs such as Weight Watchers, health coaches, diet books, Web sites such as 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.

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.

Marketdata Enterprise 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.
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 That by 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

Weight-loss medicinePerhaps 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 that 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 are 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 (OTC) 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 OTC 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 5 percent of your weight after one-year. In a person who weighs 200 pounds, this would mean 10 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 Programs

Utilizing a commercial weight-loss center or program is one of the most popular options for someone affected by obesity. Commercial weight-loss programs often provide various resources such as pre-packaged meals, support and more. Programs usually offer a 1,000 to 1,500 calorie-per-day diet plan which produces weight-loss of about 1-2 pounds per week. The slow-down of weight-loss is not unique to these approaches. It is true of any weight-loss program because as you begin to weight less, you burn fewer calories.
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 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 programs 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 Replacements
Meal replacement through pre-packaged meals can be appealing because of the convenience and ease of choices 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 could 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 Replacements
Some programs do not require meal replacement as part of their program. Their main goal is to teach you about healthy eating patterns, behavior modification and incorporating physical activity. While it is helpful long-term, behavior change does not happen overnight and can be a challenging adjustment 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, 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 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 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.

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.

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.

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 foods 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.

Founded more than 30 years ago, the Jenny Craig program offers a clinically proven comprehensive approach to weight-loss that includes nutrition, exercise and behavior modification. The program is developed by registered dietitians in consultation with an expert Science Advisory Board. It provides nutritionally balanced menus that combine portion-controlled foods with the client’s own fresh fruits and vegetables, whole grains, low-fat dairy and heart healthy fats. The program is delivered by trained personal consultants in weekly motivational one-on-one consultations, in center, over the phone or via Skype. Consultants partner with members to identify personal motivators, set weekly menu and activity plans, monitor progress, overcome obstacles and positively reinforce success.

How does it work?
A typical menu day on Jenny Craig consists of three meals and three snacks per day, which, in combination with the added grocery items, adds up to an individualized menu calorie level that is based on your gender, age, height, weight and level of physical activity. The standard menu caloric distribution is 50-60 percent carbohydrate, 20-30 percent fat and 20-30 percent protein. For the Jenny Craig for type 2 diabetes menu, the caloric distribution is 45 percent carbohydrate, 30 percent fat and 25 percent protein. Menus offer more than 80 items and provide < 10 percent calories from saturated fat and added sugars and 9 grams trans fat.

For the first half of your program, you primarily follow menus that include Jenny Craig foods for seven days a week. For special events or other times when you need an alternate option, your consultants will offer guidance for meals on your own. When you have lost half of your total weight-loss goal, you make the transition to five to six days of menus that include Jenny Craig foods and one to two days of your own foods. When you reach your goal weight, you transition to your own foods, with the option to continue with one meal/snack per day to maintain consistent calories for more successful weight maintenance. Throughout your program, you work with your consultant to utilize behavioral strategies to address challenges like emotional, social and unconscious eating and dining out, as well as to build an enjoyable, active lifestyle. The program also provides an online menu tracker/mobile app, recipes and community forums for added support.

Jenny Craig is a well-balanced, scientifically proven program on which you can expect to lose 1-2 pounds per week on average. A 2010 independent trial, published in the Journal of the American Medical Association,  demonstrated a 10 percent weight-loss for Jenny Craig participants at one year and seven percent weight-loss at two years. Based on these outcomes, as well as the program’s similarity to the CDC’s Diabetes Prevention Program (DPP) curriculum, Jenny Craig has been awarded pending recognition as a DPP program.

A 2014 clinical trial of people with type 2 diabetes demonstrated a 9 percent weight-loss at one year with greater improvements in diabetes control and heart risk factors as compared to usual care.

For both programs, Jenny Craig participants achieved three times greater weight-loss when compared to usual care. Based on their review of the effectiveness of commercial weight-loss programs in the Annals of Internal Medicine, researchers at John Hopkins University rated Jenny Craig as one of the most highly effective programs for sustainable weight-loss at one year, recommending it for physician referral and benefits coverage by health insurers/employers.

From the beginning, members are learning how to incorporate healthy foods ( a variety of non-starchy vegetables, reduced/nonfat dairy products, whole grains and heart healthy fats) into their menus. The daily menu is a model for learning nutritional balance, variety and moderation in food choices. For long-term success, it’s important to no only follow the menus but self-monitor their food and activity choices and practice behavioral strategies to both lose the weight and change their behaviors.

Counselors are not dietitians. However, they have been trained to deliver an evidence-based program that is developed by registered dietitians and recommended by the 2013 Obesity Guidelines.

Program costs include an enrollment fee of $99 with a monthly membership of $19. Daily food costs ranges between $15 and $23.

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 combined with 200 calories of your favorite healthy foods. The third meal is a “sensible meal” of about 500 calories, with 1/2 cup of your plate filled with veggies, 1/4 cup with lean protein (such as chicken without the skin), 1/4 cup 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.

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 a 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 the shakes and who can monitor for potential complications of a fast weight-loss.

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 was founded in 1963 and offers weight-loss guidance and support. The plan emphasizes a well-balanced diet and encourages lifestyle changes and increased physical activity.

How does it work?
The Weight Watchers program is called Beyond the Scale, which still emphasizes weight-loss but does it in a broader context of eating healthier, moving more and making more time for yourself. Beyond the Scale offers an approach to healthier living that allows people to personalize the program and define their own success both on and off the scale.

The Weight Watchers food plan, SmartPoints, is consistent with the 2015-2020 Dietary Guidelines for Americans to make healthier eating simple by translating complex nutrition information into one simple number, giving each food and beverage a SmartPoints value. Everything is still on the menu with SmartPoints, but it does encourage a healthier pattern of eating with more fruits, vegetables and lean proteins, and less sugar and saturated fat. Members are given a personalized daily SmartPoints target based on their height, weight, age and gender and also receive weekly SmartPoints to provide flexibility for occasions when members may eat more than usual.  With SmartPoints, people can choose the foods they want to eat at home, in restaurants, in the workplace – or anywhere else food shows up in their lives.

Fitness is also a core component of Beyond the Scale. The focus is on helping members fit fitness into their lives. Each member gets a personalized FitPoints goal based on their current level of activity and encourages using tools such as the WeightWatchers FitBreak app. Weight Watchers also has supportive tools, including helpful content and a social media community within its app called Connect.

Members can follow the program in-person at weekly group meetings or privately through its OnlinePlus or personal coaching offerings.

Weight Watcher’s Beyond the Scale program is firmly supported by science. It builds on the recommendations of the United States Preventative Services Task Force and other expert panels for lifestyle programs that work – combining dietary and physical activity recommendations with behavioral counseling, tools for self-monitoring, accessible and plentiful meeting times, and support from leaders and members through Connect and 24/7 Expert Chat.

Overall, Weight Watchers nudges members toward a healthier pattern of eating and members typically lose 1-2 pounds per week. Weight Watchers is one of the few commercial weight-loss programs whose ability to produce weight-loss has been clinically proven repeatedly through research studies.

Weight Watchers has multiple programs that range in cost: In addition to a $20 starter fee for any membership, OnlinePlus has a base rate of $19.95 per month; meetings has a base rate if $44.95 per month; and personal coaching has a base rate of $54.95 per month.

While Leaders have lived the experience (all Leaders have lost weight on Weight Watchers and kept it off) and are trained in behavioral methods to support weight-loss, they are not licensed dietitians. Therefore, if there are special dietary requirements, it is always best to consult with a dietitian. 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