A Systematic Review of Targeted Outcomes Associated with a Medically Supervised Commercial Weight-Loss Program

A 4-year Retrospective Study on the Impact of the Dietary Program on Anthropometric and Metabolic Parameters among Overweight and Obese Subjects in Primary Health Care Centers in Qatar

Aim. Obesity is a worldwide epidemic and one of the risk factors for many diseases including heart disease, diabetes mellitus, kidney disease, and cancer. The aim of this study was to review the impact of the local dietary program on anthropometric and metabolic parameters among overweight and obese subjects attending Primary Health Care Centers in Qatar from 2016 to 2019. Methods. A 4-year retrospective cohort study. Results. Among 10451 patients, the overall success rate of BMI reduction was 10% while 22.22% of population had ≥5% reduction in BMI from baseline. The median time for weight reduction was 3.2 years, with women showing earlier significant weight loss than men. The patients with 3–5 number of visits had earlier significant weight reduction than those with ≤3 visits and >5 number of visits. Greater weight reduction was seen in those with chronic diseases and who had constant follow up visits in the dietetic clinic during the study period. Conclusion. Our results are encouraging, showing improvement in the management of adult obesity with medical nutrition therapy through involvement and guidance in the community dietetic clinics. The dietetic clinic services could be an operative strategy to prevent expensive diabetic and cardiovascular events, mainly in high-risk patients.

Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles

A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern’s nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets.

Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults

BACKGROUND

Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described.

METHODS

Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants.

RESULTS

Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets.

CONCLUSION

A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.

Precision Medicine in Weight Loss and Healthy Living

Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.

High intensity lifestyle intervention and long-term impact on weight and clinical outcomes

BACKGROUND

Obesity increases the risk for diabetes and cardiovascular events, with a corresponding growth in medical costs. High intensity lifestyle intervention (HILI) is the cornerstone for weight management. We assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of program participation and comorbid conditions.

METHODS

This was a retrospective cohort study of patients who enrolled in HILI weight management programs at Health Management Resources (HMR) clinics located across the U.S. Patients completed health risk assessments (HRA) and were enrolled for up to 24 months at the time of follow-up HRA. HMR programs provide weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000 kcal/wk. A Markov model predicted avoidance of diabetes and cardiovascular events and projected cost savings due to weight loss.

RESULTS

Of the 500 patients included in the analysis, 67% were female and mean age was 54.1 years (s.d. 11.6). The baseline weight and BMI were 243.5 lbs (range 144.0-545.0) and 38.8 kg/m2 (range 25.4-85.0), respectively. Overall, patients lost an average of 47.4 lbs (18.9% of initial body weight [IBW]); the amount of weight loss was consistent among those with diabetes/pre-diabetes (50%), high/moderate risk for dyslipidemia (60%), hypertension/pre-hypertension (86%), and severe obesity (37%). The mean IBW lost was 16.4%, 19.3%, 20.7% for ≤6 months (n = 165), 7-12 months (n = 140), 13-24 months (n = 195) of program participation, respectively. The simulation model estimated 22 diabetes and 30 cardiovascular events and $1,992,370 medical costs avoided over 5 years in the 500 patients evaluated.

CONCLUSION

Patients in the HMR clinic-based HILI program achieved substantial weight loss regardless of duration of program participation, risk profile and comorbid status. The HMR program could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high risk patients.

Critical review of bariatric surgery, medically supervised diets, and behavioural interventions for weight management in adults

AIMS

Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid.

METHODS

Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention.

RESULTS

Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood.

CONCLUSION

Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.

Moderate weight loss in obese and overweight men preserves bone quality

BACKGROUND

Weight loss (WL) negatively affects bone mineral density (BMD) in older populations and has specifically been shown in women.

OBJECTIVE

In this prospective controlled trial, we examined variables of bone quality and endocrine changes after intentional WL in men.

DESIGN

Thirty-eight overweight and obese [mean ± SD body mass index (in kg/m²): 31.9 ± 4.4; age: 58 ± 6 y] men were recruited to either WL through caloric restriction or weight maintenance (WM) for 6 mo.

RESULTS

There was a -7.9 ± 4.4% and +0.2 ± 1.6% change in body weight in the WL and WM groups, respectively. There was a greater increase in femoral neck and total body BMD and bone mineral content (BMC) in the WM group than in the WL group (P-interaction effect < 0.05). In contrast, there was a trend for the tibia cortical thickness and area to decrease more in the WM group than in the WL group (P ≤ 0.08). There was a decrease in the periosteal circumference in both groups over time (P < 0.01) and no statistically significant changes in trabecular bone. Circulating total, free, and bioavailable estradiol decreased in the WL group compared with the WM group, and changes were different between groups (P < 0.05). Serum total and bioavailable testosterone increased in both groups (P < 0.01). Serum 25-hydroxyvitamin D increased to a similar extent in both groups (P < 0.05).

CONCLUSIONS

Moderate WL in overweight and obese men did not decrease BMD at any anatomical site or alter cortical and trabecular bone and geometry. Also, despite increased BMD at some sites when maintaining excess body weight, cortical bone showed a trend in the opposite direction.

Changes in physical activity during a weight loss intervention and follow-up: a randomized controlled trial

Physical activity is an important component in weight loss treatment and weight maintenance. We evaluated the physical activity component of two weight loss programmes, either standard care (SC) as defined by national guidelines, or a commercial programme (CP; Weight Watchers) over the period of weight loss and follow-up. 772 adults (mean body mass index: 31.4 ± 2.6 kg m(-2)) were recruited by primary care practices in Australia, the United Kingdom, and Germany, and randomly assigned to 12 months SC, or the CP. They were then followed up at 24 months. Change in physical activity levels were assessed by the International Physical Activity Questionnaire (IPAQ)-short form, and pedometer recordings. Both groups reported increases in physical activity using the IPAQ from baseline to 12 months and 24 months (within groups P < 0.0001) and in pedometer steps from baseline to 12 months only (within groups P < 0.0001). Differences between groups with both methods of assessment were not significant. There was a significant difference in weight loss between the groups at 12 months favouring the CP group; however, this statistical difference was not maintained at 24 months. In conclusion, despite similar increases in reported activity, there were significant differences in weight loss and regain between groups. Therefore, greater weight loss seen with the CP is unlikely to be due to increases in physical activity. Trends in pedometer steps mirrored changes in weight over time more closely than the IPAQ; however, both assessment tools have limitations. Better activity assessment measures are needed to more accurately gauge changes in physical activity during weight loss interventions.

Changes in weight loss and lipid profiles after a dietary purification program: a prospective case series

OBJECTIVE

The purpose of this case series was to describe immediate changes to weight and lipid profiles after a 21-day Standard Process whole food supplement and dietary modification program.

METHODS

Changes in weight and lipid profiles were measured for 7 participants (6 men and 1 woman) participating in a 21-day program. The dietary modifications throughout the Standard Process program were consumption of (1) unlimited fresh or frozen vegetables and fruits and preferably twice as many vegetables as fruits, (2) ½ to 1 cup of cooked lentils or brown rice each day, (3) 4 to 7 teaspoons of cold pressed oils per day, and (4) at least 64 oz of water a day. After day 10 of the program, participants were allowed to consume 1 to 2 servings of baked, broiled, or braised poultry or fish per day. Participants consumed a whey protein-based shake as meal replacement 2 times per day. Nutritional supplementation included a cleanse product on days 1 to 7, soluble fiber supplementation including oat bran concentrate and apple pectin on all days, and "green food" supplementation on days 8 to 21.

RESULTS

Weight loss ranged between 5.2 (2.4 kg) and 19.9 lb (9.0 kg) (average, 11.7 lb; 5.3 kg). Total cholesterol levels decreased with ranges between 11 and 77 mg/dL, and low-density lipoprotein cholesterol levels decreased in a range between 7 and 67 mg/dL.

CONCLUSION

After participating in a dietary program, the 7 participants demonstrated short-term weight loss and improvements in their lipid profiles.

Changes in anthropometric measurements, body composition, blood pressure, lipid profile, and testosterone in patients participating in a low-energy dietary intervention

OBJECTIVE

The purpose of this study was to describe changes in anthropometric measurements, body composition, blood pressure, lipid profile, and testosterone following a low-energy-density dietary intervention plus regimented supplementation program.

METHODS

The study design was a pre-post intervention design without a control group. Normal participants were recruited from the faculty, staff, students, and community members from a chiropractic college to participate in a 21-day weight loss program. All participants (n = 49; 36 women, 13 men; 31 ± 10.3 years of age) received freshly prepared mostly vegan meals (breakfast, lunch, and dinner) that included 1200 to 1400 daily calories (5020.8 to 5857.6 J) for the women and 1600 to 1800 (6694.4 to 7531.2 J) daily calories for the men. Nutritional supplements containing enzymes that were intended to facilitate digestion, reduce cholesterol levels, increase metabolic rate, and mediate inflammatory processes were consumed 30 minutes before each meal. The regimented supplementation program included once-daily supplementation with a green drink that contained alfalfa, wheatgrass, apple cider vinegar, and fulvic acid throughout the study period. A cleanse supplementation containing magnesium, chia, flaxseed, lemon, camu camu, cat's claw, bentonite clay, tumeric, pau d'arco, chanca piedra, stevia, zeolite clay, slippery elm, garlic, ginger, peppermint, aloe, citrus bioflavonoids, and fulvic acid was added before each meal during week 2. During week 3, the cleanse supplementation was replaced with probiotic and prebiotic supplementation.

RESULTS

Multiple paired t tests detected clinically meaningful reductions in weight (- 8.7 ± 5.54 lb) (- 3.9 ± 2.5 kg), total cholesterol (- 30.0 ± 29.77 mg/dL), and low-density lipoprotein cholesterol (- 21.0 ± 25.20 mg/dL) (P < .05). There was a pre-post intervention increase in testosterone for men (111.0 ± 121.13 ng/dL, P < .05).

CONCLUSIONS

Weight loss and improvements in total cholesterol and low-density lipoprotein cholesterol levels occurred after a low-energy-density dietary intervention plus regimented supplementation program.

Effects of tea combined with high-protein meal replacement shakes on anthropometric measurements, lipid profiles, cellular biochemistry, neurochemistry, and microbial metabolism: a prospective observational study

OBJECTIVE

The purpose of this study was to report preliminary data on the effects of tea and high-protein meal replacement shakes on weight loss, waist-to-hip ratios, and lipid profiles in healthy subjects. Secondary analyses of urine samples assessed pre-post changes in cellular biochemistry, neurochemistry, and microbial metabolism.

METHODS

This study used a pre-post intervention design without a control group. Thirty healthy subjects (20-60 years of age; 23 women and 7 men) participated in a 28-day diet intervention program consisting of a cleansing day and 6 restricted diet days per week. On cleansing days, the subjects drank 4 oz of tea 4 times per day with a recommendation to drink at least 64 oz of filtered water. On the restricted diet days, the subjects drank 2 high-protein meal replacement shakes, consumed one 400- to 600-cal (1674.3-2511.5 joules) meal consisting of low-glycemic index foods, and drank at least 64 oz of filtered water.

RESULTS

Multiple paired t tests detected reductions in weight (6.4 lb), waist (1.9 in), and hip (1.1 in) measurements and in total cholesterol (13.3 mg/dL) and low-density lipoprotein cholesterol (11.4 mg/dL) (P < .05). Multiple paired t tests detected significant increases in energy metabolism from carbohydrates and amino acids and concomitant increases in oxidative stress (P < .05).

CONCLUSION

The data support the concept that a low-glycemic load diet intervention incorporating tea and high-protein meal replacement shakes may cause weight loss and improve lipid profiles. The significant physiologic changes from the urine samples did not reflect meaningful metabolic effects.

Program adherence and effectiveness of a commercial nutrition program: the metabolic balance study

Objective. To assess the effectiveness of a commercial nutrition program in improving weight, blood lipids, and health-related quality of life (HRQOL). Methods. Prospective observational study with followup after 1, 3, 6, and 12 months with data from questionnaires and blood samples. Subjects. After 12 months, we had data from 524 subjects (= 60.6% of the initial samples). 84.1% of the subjects were women. The average BMI at baseline was 30.3 (SD = 5.7). Results. After 12 months, the average weight loss was 6.8 kg (SD = 7.1 kg). Program adherence declined over time but was still high after 12 months and showed a positive linear correlation with weight loss. Relevant blood parameters as well as HRQOL improved significantly. Conclusion. After 12 months, nearly two thirds of the samples had achieved >5% reduction of their initial weights. The high degree of program adherence is probably due to personal counseling and individually designed nutrition plans provided by the program.