Self-help weight loss versus a structured commercial program after 26 weeks: A randomized controlled study

PURPOSE: There have been few randomized controlled trials of commercial wei ght-loss programs. This ongoing study compares the effects of a self-help p rogram and a commercial program on weight loss and other measures of obesit y in overweight and obese men and women. SUBJECTS AND METHODS: We report the results of the first 26 weeks of a mult icenter, randomized, 2-year study of 423 subjects who had a body mass index of 27 to 40 kg/m(2). Subjects were randomly assigned to either a self-help program, consisting of two 20-minute sessions with a nutritionist and prov ision of printed materials and other self-help resources, or to attendance at meetings of a commercial program (Weight Watchers). Outcome measures wer e changes in body weight, body mass index, waist circumference, and body fa t. Changes in serum homocysteine levels were measured in a subsample of par ticipants during the first 12 weeks. RESULTS: After 26 weeks, subjects in the commercial program, as compared wi th those in the self-help program, had greater decreases in body weight [me an (+/- SD) -4.8 +/- 5.6 vs -1.4 +/- 4.7 kg] and body mass index (-1.7 +/- 1.9 vs -0.5 +/- 1.6 kg/m(2), both P <0.001) in intention-to-treat analyses. Among subjects measured at week 26, mean waist circumference (-4.3 +/- 10. 5 vs -0.7 +/- 12.7 cm) and fat mass (-3.8 +/- 7.0 vs -1.5 +/- 7.6 kg, both P <0.05) also decreased more among subjects in the commercial program. Mean serum homocysteine levels improved in the commercial program compared with self-help (-0.5 +/- 1.3 vs 0.9 +/- 1.8 mu M, P <0.05). CONCLUSIONS: A structured commercial weight-loss program is more likely to be effective for managing moderately overweight patients than brief counsel ing and self-help. Am J Med. 2000;109:282-287. (C) 2000 by Excerpta Medica, Inc.