Review: little evidence supports the efficacy of major commercial and organized self-help weight loss programs.

M e t h o d s Data sources: MEDLINE (1966 to October 1, 2003), bibliographies of relevant studies, and the publication lists of 2 companies. Study selection and assessment: Randomized controlled trials (RCTs) or prospective case series studies of major commercial or organized self-help weight loss programs in the United States. Included studies provided regular in-person or online counseling for ≥ 12 weeks, included only adults, reported number of trial participants, assessed ≥ 10 participants, evaluated the program under the same conditions in which it was offered to the public, and had ≥ 1-year follow-up after treatment. Studies of self-help weightloss approaches based on books, mealreplacement plans, or similar products were excluded. Quality assessment included study design and attrition. Outcome: Weight loss. M a i n r e s u l t s 10 studies (n = 1879) met the selection criteria. 3 RCTs (n = 551) assessed a nonmedical program (Weight Watchers). Of these, 1 RCT (n = 423) reported that participants attending Weight Watchers meetings had a mean loss of 3.2% of initial weight at 2 years compared with 0% in participants assigned to a self-help intervention that included 2 dietitian visits (P < 0.001). 5 studies (n = 1048) assessed physiciansupervised weight loss programs: 3 of Health Management Resources (Boston, Massachusetts) and 2 of OPTIFAST (Novartis Nutrition, Minneapolis, Minnesota). Both programs offered meal-replacement products as part of a low-calorie or very-low-calorie diet with a curriculum of lifestyle modification. 1 of these 5 studies was an RCT. The RCT (n = 40) compared meal-replacement products alone with meal-replacement products plus usual table foods in patients with type 2 diabetes and obesity but did not report between-group differences in weight loss at 1 year. 1 RCT (n = 46) assessed a commercial Internet-based weight loss program (eDiets. com). At 1 year, participants in the Internet-based program lost 1.1% of their initial weight compared with 4.0% in participants who used a behavioral weight loss manual (P = 0.04). 1 RCT (n = 234) assessed an organized self-help program (Take Off Pounds Sensibly [TOPS]). At 1 year, the TOPS program was less effective than a therapist-led behavioral modification program for achieving weight loss (P value between groups not provided).