Therapeutics

Weight loss was greater with Weight Watchers than with a behavioral program plus Weight Watchers

Pinto AM, Fava JL, Hoffmann DA, Wing RR. Combining behavioral weight loss treatment and a commercial program: a randomized clinical trial. Obesity (Silver Spring). 2013;21:673-80.

Clinical impact rating: F ★★★★★✩✩ Question

Conclusion

In overweight or obese adults, does adding a behavioral weight loss (BWL) program to Weight Watchers (WW) increase weight loss compared with WW or BWL alone?

In overweight or obese adults, Weight Watchers alone led to greater weight loss than adding a behavioral weight loss program to Weight Watchers.

Methods

*Information provided by author.

Design: Randomized controlled trial. ClinicalTrials.gov NCT00827593. Allocation: {Concealed}*.† Blinding: Blinded† (data collectors and {data analyst}*). Follow-up period: 48 weeks. Setting: New York City, New York, USA. Participants: 144 persons 30 to 65 years of age (mean age 50 y, 90% women, mean body mass index [BMI] 36 kg/m2) with a BMI 27 to 50 kg/m2 recruited by newspaper advertisements. Exclusion criteria included current or recent weight loss program or medication, planned bariatric surgery, loss of ≥ 5% body weight in past 6 months, type 2 diabetes with treatment that increased risk for hypoglycemia, or significant psychiatric illness. Intervention: BWL weekly for 12 weeks followed by WW weekly for 36 weeks (n = 47); WW weekly for 48 weeks (n = 49); or BWL weekly for 24 weeks, then biweekly for 24 weeks (n = 48). BWL comprised protocol-driven, closed-group, 60-minute sessions with about 15 participants; a moderately reduced-calorie diet; and a goal to increase physical activity to 200 min/wk. WW comprised open-group meetings; food, activity, and behavior modification plans; a moderate energy-deficit diet; and regular physical activity. Outcomes: Weight change at 24 and 48 weeks. Secondary outcomes included loss of ≥ 10% body weight. Patient follow-up: 88% at 24 weeks and 78% at 48 weeks.

Main results Mean weight change did not differ between the 3 groups at 24 weeks. At 48 weeks, weight loss was less in BWL plus WW than with WW alone (Table). More participants lost ≥ 10% body weight at 48 weeks with WW than BWL plus WW or BWL alone (Table). Behavioral weight loss (BWL) program plus Weight Watchers (WW) vs WW or BWL alone for overweight and obese adults‡ Outcomes

Weight loss (kg)

Mean change from baseline BWL + WW WW BWL −3.6

2.4 (0.2 to 4.6)

0.032

−5.4

1.8 (−0.5 to 4.1)

Not significant

−5.4

−0.6 (−2.8 to 1.7)

Not significant

RBR/RBI (CI)

NNH/NNT (CI)

−6.0

−3.6 −6.0

Event rates Loss of ≥ 10% body weight

15%

37%

15%

RBR 58% (11 to 81) 13%

37%

At 48 wk Mean difference P value (95% CI)§

13%

NNH 5 (3 to 27)

RBI 17% (−56 to 210) Not significant RBI 182% (28 to 545)

NNT 5 (3 to 16)

‡RBR = relative benefit reduction; other abbreviations defined in Glossary. RBR, RBI, NNH, NNT, and CI calculated from raw data provided by author. §Estimates provided by author.

19 November 2013 | ACP Journal Club | Volume 159 • Number 10

†See Glossary.

Sources of funding: National Institute of Diabetes and Digestive and Kidney Diseases. Weight Watchers International provided vouchers for registration and meetings. For correspondence: Dr. A.M. Pinto, City University of New York, New York, NY, USA. E-mail [email protected]. ■

Commentary We know that several therapies, including individual and group counseling, behavioral strategies, prepackaged meals, obesity medications, and bariatric surgery, help patients to achieve the clinically important 5% to 10% body weight loss and associated health benefits (1, 2). Pinto and colleagues address the question of how to scale up effective interventions to large populations. Behavioral therapy is known to be effective but is limited by high costs and the need for trained professionals for administration. WW costs less and does not require highly trained professionals, has been shown to support moderate weight loss, and is generally wellregarded by participants (3). Pinto and colleagues hoped to show that combining a brief BWL intervention followed by a standard WW program would increase weight loss compared with WW alone, but at a cost that could allow widespread scaling. Surprisingly, the BWL plus WW group lost less weight than WW alone. Message inconsistency could play a role in these results. Patients enrolled in consistent therapy with either WW or BWL lost more weight and had better attendance than the BWL plus WW group. We surmise that BWL plus WW might have added mixed messages and confusion for patients. Follow-up investigations should refine the interventions as appropriate, ensuring consistent messaging within intervention groups. A broader range of outcome measures, such as knowledge, selfefficacy, and psychosocial variables should be included. Studies should also attempt to lengthen the duration and refine the interventions as needed to support maintenance of weight loss. Scott Kahan, MD, MPH George Washington University Washington, DC, USA Robyn Osborn, PhD National Center for Weight & Wellness Washington, DC, USA References 1. Knowler WC, Fowler SE, Hamman RF, et al; Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677-86. 2. Shaw K, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005;2: CD003818. 3. Jebb SA, Ahern AL, Olson AD, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. Lancet. 2011;378:1485-92.

© 2013 American College of Physicians

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ACP Journal Club. Weight loss was greater with Weight Watchers than with a behavioral program plus Weight Watchers.

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