Experts Assess What Works for Weight Loss10/03/11
MONDAY , Oct. 3 (HealthDay News) -- Weight loss programs that
focus on changing behaviors, as well as those that combine behavior
changes and weight-loss medications such as orlistat (Alli,
Xenical), can help people shed pounds, according to a new
"We found behaviorally based weight loss programs are generally effective for weight loss," said Dr. Erin LeBlanc, an investigator for Kaiser Permanente Center for Health Research in Portland, Ore.
LeBlanc declined to mention particular behavioral intervention
programs by name. However, components of commercial programs such
as Weight Watchers, Jenny Craig and others include group support,
encouragement of physical activity, setting of goals and other
The study is published in the Oct. 4 issue of the
Annals of Internal Medicine.
LeBlanc and her colleagues were asked by the U.S. Preventive
Services Task Force (USPSTF) -- a federal government panel that
routinely issues guidelines on various medical issues -- to look at
evidence on the effectiveness of various weight loss interventions.
In 2003, the USPSTF recommended that doctors screen all adults for
obesity and offer behavioral interventions for those who are obese
-- people with a body mass index (BMI) of 30 or above.
The USPSTF hopes to update those recommendations, so it asked
LeBlanc's group to revisit the issue, looking over the newest
In all, the team reviewed 58 published trials involving
overweight adults. Some had received behavioral treatment only,
while some got behavioral treatment plus weight-loss
Use of behavior-based weight loss programs resulted in people
dropping an average 6.6 more pounds over 12 to 18 months than if
they had attempted to slim down without such programs, the
researchers reported. People who went to 12 to 26 intervention
sessions during the first year on such programs lost 9 to 15
pounds, whereas those in the comparison groups lost little or no
After 12 months, those who used the weight-loss drug orlistat
along with a behavioral weight-loss program lost 11 to 22 pounds on
average (about 8 percent of their starting weight). In comparison,
people who had taken a placebo while they were on a weight loss
program lost an average of between 7 and 13 pounds, the researchers
Research on the diabetes drug metformin -- used off-label for
weight loss -- is limited, LeBlanc's team said. Two studies
evaluated by the researchers included people with so-called
"prediabetes." Those who took metformin and engaged in a behavioral
weight-loss program lost about 4 to 9 pounds, on average, compared
to a loss of less than 2 pounds in those who just had behavioral
A typical behavior-based program studied had multiple parts,
LeBlanc said. For instance, a program might offer group education
sessions, individual counseling, or a combination, and also
encourage physical activity. These programs would also encourage
participants to monitor themselves and set goals.
LeBlanc's team encountered some trouble evaluating the data,
especially regarding the medication studies, which typically had
high dropout rates (often because of gastrointestinal symptoms).
These studies often didn't include enough participants to
accurately assess side effects, either, the researchers said.
And while those people who took orlistat typically experienced
more weight loss, "we don't know what happens when they quit [the
drug]," LeBlanc noted.
The FDA revised the warning label for orlistat in 2010, alerting
users to a rare but severe risk for liver injury. The label
revision applied to both Alli, sold over the counter, and Xenical,
the prescription form.
"Our evidence says that the benefits of weight loss drugs have to be weighed against the risks," LeBlanc said.
Dr. Frank Greenway, professor and chief of the outpatient clinic
at the Pennington Biomedical Research Center in Baton Rouge, La.,
called the weight-loss results "underwhelming."
While a small percent of people may take weight off short term,
few keep it off long term, he said.
Another expert agreed. The new study "confirms what we knew,"
said Dr. Robin Blackstone, president of the American Society for
Metabolic & Bariatric Surgery and a bariatric surgeon in
Scottsdale. "Medical weight loss is not very robust, but it [diet
medication] does have an effect."
The bariatric surgery community, she said, is supportive of
people trying behavioral and medical interventions first, before
they head to surgery. For some, she said, surgery may eventually be
a more effective option. "I think evidence is beginning to show
that there are people with a very high propensity to being big,"
she said. "They're fighting against that their whole life."
Blackstone reports consulting work for Johnson & Johnson.
She is conducting a research study for EnteroMedics, which is
developing an obesity treatment.
Find out more about maintaining a healthy weight at the
U.S. National Heart, Lung, and Blood
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