Weight Loss Plans — Over-Marketed and Under-Regulated

With so many to choose from, finding a weight-loss program that works for you should be easy to do, right?

Finding a weight-loss program may be easy, but choosing one that is proven to be effective and based on expert guidelines, is hard to do, as researchers at Johns Hopkins and the University of Maryland found out.

As one researcher put it, “The nutrition and weight-loss industry is like the Wild West.”

The researchers reviewed the websites of nearly 200 weight-loss programs in Maryland, Washington, DC and Virginia. They looked at a mix of commercial weight-loss programs, physician-supervised programs, those associated with bariatric surgery practices, as well as independently-operated programs.

Given the number people who are overweight in the U.S. and how many weight-loss programs there are, and given the serious — and costly — health problems associated with being overweight, one would think that good programs would be common, particularly in a metropolitan area. But many appear to be more geared toward attracting customers than producing results.

“The nutrition and weight-loss industry is like the Wild West,” researcher Kimberly Gudzune, of Johns Hopkins University School of Medicine, said in a statement. “There is very little oversight, and it's hard for consumers and medical professionals alike to tell what is effective, reliable and meets guidelines' standards,” she added.

The team used five criteria to evaluate a weight-loss program:

1) Did the program offer enough intensity — interventions equal to at least 14 sessions over six months?

2) Did it include a moderately low-calorie diet, based on scientific evidence, such as the Mediterranean diet or the lacto-ovo vegetarian diet?

3) Did it encourage increased physical activity?

4) Did it include self-monitoring tools to plan meals and track diet, exercise, and weight?

5) Did the program distribute or recommend dietary supplements?

Only nine percent of the programs reviewed followed the kinds of professional medical guidelines for weight-loss issued by the American Heart Association (AHA), the American College of Cardiology (ACC) and The Obesity Society (TOS). While the programs' websites described the specifics of the program’s “intensity,” just 17 percent qualified as high-intensity programs.

Many of the programs appeared to emphasize marketing over actual results. Most promoted dietary change and exercise as part of their weight-loss plans, but they didn’t always specify the type of dietary change, and just three percent met the recommendation of at least 150 minutes a week of physical activity. Only about half of the programs used any type of behavioral strategies. FDA-approved prescription medications were encouraged by only 15 percent of programs, yet over twice that number endorsed dietary supplements.

When there is inadequate intervention and follow-up, people are less likely to stay with a program. And without knowing the type of diet they are signing up for, how can they know if it is something they can live with?

The Johns Hopkins researchers found many programs simply don't follow the basic guidelines for weight-loss — they don't require physical activity or even self-monitoring. And though there is no scientific proof that dietary supplements, whether vitamins, minerals or herbal products, help you lose weight, they are promoted, even though they can cause side effects as serious as heart damage.

“….[M]any consumers… could lose more weight from their wallets than their waists.”

Eighty of the weight-loss programs evaluated were randomly selected for follow-up with a phone survey. Fifty programs responded, and data collected from phone interviews were compared to information provided on the programs’ websites.

While fewer than 60 percent of the websites adequately described their adherence to the criteria used for program evaluation, those interviewed gave detailed descriptions of these key weight-loss elements as they occurred in their facilities, suggesting again that marketing may be trumping verifiable outcomes.

This suggests that somebody should be minding the store. There needs to be some type of expert oversight of the information given out by weight-loss programs that claim to be successful, especially since these programs can be very costly to consumers. Programs can cost as much as $600 per month, and many are not covered by insurance.

As Gudzune put it, “….[M]any consumers… could lose more weight from their wallets than their waists.”

There are consumer protection laws that regulate the advertising claims made by the weight-loss and dietary supplement industries, but there is no oversight requiring weight-loss programs to be open about their practices or their adherence to expert criteria established by medical organizations.

The inability to find or have access to programs that adhere to expert guidelines on weight-loss is of particular concern for those with serious health problems related to their weight. Previous research has found that 29 to 49 percent of Americans are looking for ways to lose weight, often because of their health. The cost of obesity and its health-related conditions are estimated to be $147 billion a year in terms of health care and lost productivity.

The study is published in the journal, Obesity.