Sorting Out Weight-Loss Programs that Meet Weight Management Guidelines

Study assessing information provided by commercial weight loss programs puts spotlight on limits of these interventions in meeting most guidelines, and falls short in fulfilling full range of services.

with Kimberly A. Gudzune, MD, MPH, and J. Michael Gonzalez-Campoy, MD, PhD

Given that two-thirds of adults across the United States are facing overweight and obesity, patients have figure out which weight loss program may appeal to them. Clinicians can and should guide their patients as to the efficacy of options available and best suited to the individual's needs. 

To help with this, researchers at Johns Hopkins School of Medicine looked at 191 different weight loss programs located in the Maryland-Washington, DC-Virginia region to see how well these programs adhered to consensus recommendations—Yet, only 1% closely followed guidelines.

Ninety-one percent (91%) of weight loss programs in this regional sample had a low adherence to meeting guideline recommendations, according to information provided on program websites. A wide scope of important details simply were unavailable if someone tried to find them online, like the program’s intensity level, diet regimen, physical activity, and use of behavioral strategies.

Young woman evaluates package information before making a purchase.

According to Kimberly A. Gudzune, MD, MPH, an assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland, this is a significant findings as it illustrates the realities patients face when they are trying to choose a weight loss program—information is simply sparse.

The Best Weight Loss Program Meets Recommended Criteria

The American Heart Association, American College of Cardiology, and the Obesity Society (AHA/ACC/OBS) published criteria for an effective, comprehensive lifestyle intervention program.

“These guidelines are critical in this respect—they help patients and doctors sort through the options and find the most beneficial weight loss programs out there,” said Dr. Gudzune.

A comprehensive program should feature:1

  • A moderately-reduced caloric meal plan
  • A regimen for increased physical activity
  • A behavioral therapy strategy
  • In addition, pharmacotherapy may be a useful weight loss tool2

While the climate on weight management is improveing, most doctors lack the time or training to focus on the specifics of formal weight loss interventions. “When we do studies looking at encounters between patients and physicians, often the physician’s advice is a little nonspecific or basic,” said Dr. Gudzune. so the guidelines help by providing a standardized framework for the right weight loss program. 

A majority (75%) of the programs endorsed some form of dieting, but it was impossible to find out the diet type. Many programs (57%) described some type of exercise, but only 3% met the recommended goal: 150 minutes or more of moderate physical activity every week. The usage of behavioral strategies, the prescription of FDA-approved medications, and even the intensity of the program—all of these parameters were either underreported or missing from the programs.1

This was disconcerting considering 29% of the programs were physician-supervised, which could mean some physicians were working directly with patients through these programs but not working within the recommendations of professional guidelines.

At present, patients are best off making a phone call to potential programs to get the details they need to help them in making a selection but this is not a guaranteed solution. Dr. Gudzune indicated that only 27% of the programs permitted a representative agree to a telephone interview, and 40% of the time,1 the information provided over the phone contradicted information that was indicated on their websites, making the information from both sources less reliable.

For instance, 21% of the programs endorsed supplements during the phone interview, while no mention of supplements was made through the website.1 Dietary supplements, nutraceuticals, and other products not approved by the FDA should be discussed between a doctor and patient, but if patients are not aware of these products from the outset, they could be left out of the conversation.

“I think when doctors talk with patients, cost should also be considered in the discussion because it is a very relevant issue for all patients,” specifically given the enormous expense of some weight loss programs, which is another detail not openly advertised. As such, it can be difficult for low income patients to entertain a formal weight loss program as they are still often out-of-pocket expenses, or continguent upon employment plans.

Selecting a Good Weight Management Intervention Is a Consumer Call
Ultimately, patients looking for the right weight loss program must do the research just as they might look for the right car or the best refridgerator—comparision shopping is a necessity.

While the Federal Trade Commission (FTC) does regulate the claims made by weight loss and dietary supplement companies,3 there could be a need to expand this requirement to correspond with professional guidelines. After all, 19% of the programs that agreed to phone interview actually were guideline concordant.

However, the power likely lies with the consumer to prompt better advertising, perhaps even better overall quality in the programs. If doctors encourage patients to call and ask for such details, companies may be more proactive about updating their websites with guideline-concordant information. Then, medical associations could step in, offering a “seal of approval” to help guide patients to the most guideline-adherent programs.

“That might be a faster way to verify and provide some credibility and really highlight those programs that are doing the good work because there are some out there that really should be recognized and used by folks, but given the sea of information that is out there, they can be really hard for people to find,” said Dr. Gudzune.

Broader Anaylysis of Weight Management Interventions Is Needed

J. Michael Gonzalez-Campoy, MD, PhD, FACE, medical director and chief executive officer of the Minnesota Center for Obesity, Metabolism, and Endocrinology in Eagan, Minnesota offered to review the study at the behest of EndocrineWeb.

"The current paper has two major pitfalls," he said. "The first issue with this report is that only commercial weight loss programs were identified, most of which have a service or product to sell, then the researchers tried to apply clinical practice guidelines to them. Since most of these centers are not formal medical practices, there is little likelihood that they would adhere to clinical practice guidelines."

The second major concern is that the authors used one particular clinical practice guideline to measure the weight loss programs against, which according to its authors, was outdated before it was even finalized. Since the selected guideline was published before many antiobesity drugs entered the US market, it does not include recommendations for the pharmacotherapy of obesity, which is a critical strategy for many individuals.2

"The point is well taken that there is too much commercialism—selling products with a promise of unrealistic achievements. Since obesity is a chronic disease, patients are best served seeking the expertise of clinicians recognized by the American Board of Obesity Medicine (ABOM)," says Dr. Gonzalez-Campoy.

The ABOM was established in 2011 to provide certification of physicians with a focus of practice in obesity medicine. Diplomates of the ABOM are recognized experts in the field of obesity medicine. Clinicians may want to recommend that their patients seek out programs directed by a physician with these credentials, he says.

To Offer Pharmacotherapy or Not Is a Dividing Line

Dr. Gudzune responded to Dr. Gonzalez-Campoy’s comments about the reliance only on the AHA/ACC/TOS guideline,2 stating that the criteria were recognized as the “foundation of any program,” regardless of whether pharmacotherapy was offered or not. In the study,1 only 15% of the programs reported using FDA-approved medications.

“Weight loss medications can be a complimentary strategy to enhance these key elements for programs that are physician supervised—in fact, this strategy is how these other guidelines recommend that they be used,” said Dr. Gudzune.

Dr. Gudzune et al decided against comparing the programs to other guidelines, including those that incorporate pharmacotherapy practices, such as those issued by the Obesity Medicine Association and the Endocrine Society because the majority of the weight loss programs examined in this study were not physician-supervised, which meant they could not legally prescribe FDA-approved medications.

Also, medications for weight loss are not indicated for all patients, as they can have signficant adverse side effects and risks that many people. Many of these drugs, like lorcaserin or phentermine/topiramate, can be expensive and not covered by the patient’s insurance, which could make them inaccessible to some patients, said Dr. Gudzune.

“Requiring weight loss medications as a key element would have unfairly penalized quality programs that do not have a physician involved, which would be a disservice to the field," she said. " Physician-supervised programs are not the only viable pathway to evidence-based weight loss.”

Study coauthor Benjamin Bloom, MD, was supported by the Medical Student Research Program in Diabetes at Johns Hopkins University – University of Maryland Diabetes Research Center from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Gudzune was supported by a career development award from the National Heart, Lung, and Blood Institute.

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