Weight Loss Interventions

Obesity is linked to serious health problems.  Weight loss or weight management has therefore become a centerpiece for many wellness programs.  The research is not completely clear on exactly what is an unhealthy weight and stressing over weight and appearance isn’t exactly good for people’s health either.  The research also hasn’t been conclusive on what interventions work well for weight management.  The US Preventive Services Task Force issues a recommendation, and a summary of supporting research, which are carried in the Journal of the American Medical Association.   (JAMA Article)   The goal of lowering weight should be to lower the risk of diabetes, high blood pressure and heart disease, which are linked to being obese.  Supposedly, around 35% to 40% of adults in the US are obese, which is astounding in itself.  Following a review of the research, the Task Force recommended that doctors offer obese patients behavioral interventions, finding there was moderate certainty regarding the benefits of such interventions.  The moderate rating means there were some methodological issues with the underlying studies and there is some possibility that more research could change the conclusion.

The research review looked at a number of studies.  The reviewers looked only at randomized clinical trials of various behavioral weight management interventions, some coupled with medication.  The followup periods were generally fairly limited, from 12 to 18 months.  For the trials that looked at actual ultimate outcomes, like mortality, there was little difference shown from the intervention to the control group, probably because few studies actually looked at these outcomes.  For the intermediate outcomes of weight loss, and keeping weight off, behavioral interventions showed what I would consider to be pretty modest effects.  Participants lost about 5 more pounds than controls and were slightly more likely to keep some of the weight off for an extended period.  But the interventions were so heterogeneous that it was difficult to identify specific features of an intervention that might have caused the success in achieving an outcome.  A couple of trials showed somewhat less likelihood of developing diabetes.  In the trials that involved medications, there was some finding that the medication might be associated with better weight loss, but as you would expect, the drugs also caused some adverse events.  In my opinion, not an overwhelmingly endorsement of behavioral interventions, but better than doing nothing for a very serious public health issue.  The science of weight reduction has a distance to go.