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Efficacy of Commercial Weight-Loss Programs

TO THE EDITOR: Gudzune and colleagues' review (1) underscores the need to enhance the modest weight loss that lifestyle or behavioral interventions typically produce. However, the manner in which they convey the designs and results of the included trials, although succinct, could be misinterpreted. First, the authors describe the comparators for the commercial programs as control/education (that is, placebo) or behavioral counseling (that is, active control). Behavioral counseling does not completely describe the comparator interventions, many of which included dietary and physical activity counseling over many visits and some of which differed only in terms of the macronutrient composition (24). Second, the authors summarize the results as mean differences between the commercial programs and their comparators, emphasizing comparative effectiveness instead of overall effectiveness (that is, changes from baseline). For example, they report the results of the Atkins studies as 0.1% to 2.9% greater weight loss at 12 months than counseling, but the weight loss achieved during the study for the Atkins interventions ranged from 3.4% to 12.9%. Thus, reporting additional summary data for an intervention, such as mean weight loss from baseline with a CI, would also be informative. The editorial mentions the possible misinterpretation of results presented in this way by stating that these programs caused negligible to modest weight loss (5). A more accurate statement would be negligible to modest additional weight loss compared with programs of established effectiveness. Because many participants have achieved substantial weight loss with these commercial programs, we should be cautious about discouraging their use on the basis of their average comparative effectiveness.