Overweight or obese women who were assigned to a structured weight-loss program with free prepared meals lost a significantly greater amount of weight at 2 years than did those who received usual care.
In addition, a greater proportion of women enrolled in the program maintained a 5% weight loss at 2 years than did those who received usual care.
“For clinical practitioners, the evidence suggests that the structured program as applied in this study provides another route for their overweight or obese patients to achieve and maintain weight loss through behavioral changes for at least a 2-year period,” researchers led by Cheryl L. Rock, Ph.D., of the University of California, San Diego School of Medicine, wrote in a study published online Oct. 9 in JAMA.
For the study, 442 overweight or obese women at one of four study sites were randomly assigned to one of three groups: an in-person center-based intervention group, a telephone-based intervention group, or a usual care group.
Women in the intervention groups received free one-on-one weight-loss counseling for 2 years, and were educated on recommendations for a nutritionally sound, reduced-calorie diet with 20-30% of calories from fat, and 30 minutes of physical exercise at least 5 days per week (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503]). They also received free access to prepackaged prepared foods from Jenny Craig Inc. to help them achieve their nutritional goals.
“Over time, participants were transitioned to a meal plan based mainly not on food provided from the commercial program, although participants could choose to include one prepackaged meal per day during weight-loss maintenance,” Dr. Rock and her associates noted.
Women assigned to the usual care group received a 1-hour consultation with a dietetics professional at baseline and at 6 months. During these sessions, they received publicly available materials on dietary and physical activity recommendations to achieve and maintain weight loss, as well as sample meal plans and advice on reading food labels and estimating serving sizes. Women in this group were followed up monthly via e-mail or telephone contact.
All study participants received $25 for each completed clinic visit, but no payment was provided for participating in the intervention or counseling sessions.
The mean age of study participants was 44 years, and 73% were non-Hispanic white. At 2 years, 407 participants remained in the trial, for a retention rate of 92%. The mean weight loss was 7.4 kg in the center-based group, 6.2 kg in the telephone-based group, and 2.0 kg in the usual care group. In addition, 62% in the center-based group and 56% in the telephone-based group had maintained a weight loss of at least 5% by the end of the study period, compared with just 29% in the usual care group.
A reduction in C-reactive protein levels and improvement in leptin levels were greater in both intervention groups compared with the usual care group, but there were no significant intervention effects on other measures, including cardiopulmonary fitness, cholesterol levels, physical or mental quality of life, or depression.
Dr. Rock and her associates acknowledged certain limitations of the study, including the fact that the prepackaged foods were provided free of charge. If women in the intervention groups were paying out-of-pocket, participant food costs would have averaged $85 per week for a total of $4,080 for the year, they wrote. “For the second year of the program, when participants transitioned to their own foods, food costs would have averaged $45 per week for a total of $2,160 for the year.”
They also noted that weight-loss program counselors were unblinded, “which may have influenced their behavior and effectiveness, although they were instructed to provide the program and services as designed to be delivered to paying customers.”
In an accompanying editorial, Rena R. Wing, Ph.D., wrote, “The findings of this trial raise the possibility that if structured commercial weight-loss programs could be provided free-of-charge to participants, both retention and average weight-loss outcomes might be far better than when participants must pay for these programs. Currently, insurance companies will cover the cost of bariatric surgery for obesity (estimated at $19,000-$29,000 per patient from insurance data), but they do not cover the cost of commercial weight-loss programs (such as that evaluated in this study, with estimated costs of approximately $1,600 for 12 weeks of the program and for food).”
Dr. Wing, director of the Weight Control and Diabetes Research Center at Miriam Hospital, Providence, R.I., continued: “Providing commercial weight-loss programs free-of-charge to participants might be a worthwhile health care investment. Future studies should directly compare the outcomes achieved in a variety of different commercial weight-loss programs and examine whether providing these programs free-of-charge to participants would be a cost-effective approach” (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1529).