Efficacy of commercial weight-loss programs: an updated systematic review.

BACKGROUND Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear. PURPOSE To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults. DATA SOURCES MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff. STUDY SELECTION Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only). DATA EXTRACTION Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias. DATA SYNTHESIS We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs. LIMITATION Many trials were short (<12 months), had high attrition, and lacked blinding. CONCLUSION Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed. PRIMARY FUNDING SOURCE None. ( PROSPERO CRD4201-4007155).