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What Works for Long-Term Weight Loss? It’s Complicated

Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. A new study reviewed the evidence for the effectiveness and monetary value of weight-management programs for adults with severe obesity. The researchers compared surgery for obesity, diet and exercise, and the drug orlistat

The UK researchers examined 131 trials, 26 UK studies, 33 studies of people’s views and 46 studies of the value for money of weight management programs. They undertook new research on the value for money of different weight-management approaches for the National Health Service (NHS) in the United Kingdom. 

What Did The Study Find?

Surgery for obesity had the best weight-loss results and could be a good use of overall resources, compared with no surgery or weight loss programs. Of non-surgical approaches, very low-calorie diets produced the best weight-loss result at 12 months, but it was unclear if this was sustained for longer. 

The best results for long-term non-surgical weight loss over nearly 10 years came from a weight loss program with a low-fat reducing diet, a calorie goal of 1200–1800 kcal/day, initial meal replacements or meal plans, a tailored exercise program, cognitive–behavioral therapy, intensive group and individual support, and follow-up by telephone or e-mail. This approach would also be most costly. 

Low-carbohydrate diets, higher protein intakes or the use of meal replacements had small effects on improving weight loss at 12 months but had no longer-term effect. Increasing physical activity helped to prevent long-term weight regain, as did receiving longer-term help with diet or using orlistat.

Adding telephone or internet support, and group support, also helped to keep weight off. Participants valued novelty in weight loss programs, weight loss programs endorsed by health-care providers and belonging to a group with people who shared similar issues.

Clinical implications to consider include: 

  1. Roux-en-Y gastric bypass surgery was the most cost-effective weight-loss strategy, favored over lifestyle WMPs and current population obesity trends. However, shorter time horizons and higher discount rates reduced the cost-effectiveness of bariatric surgery and RYGB might not then be the most cost-effective use of resources. In such cases, a less intensive lifestyle WMP might be a short-term cost-effective alternative. However, shorter time horizons may be insufficient to capture all of the relevant long-term benefits and cost savings of the obesity-related diseases avoided as a result of surgery.
  2. Bariatric surgery tended to be more cost-effective in younger people and people without comorbidities. However, there were no comparable subgroup analyses in studies evaluating lifestyle WMPs.
  3. Adding a very low calorie diet to a weight loss program was not cost-effective; however, a very low calorie diet with a weight loss program was cost-effective compared with current population trends. Furthermore, very low calorie diets might reduce the number of dropouts and increase motivation.
  4. Diets with low-carbohydrate (< 40 g/day) or higher protein content (≥ 30% energy) or with the addition of meal replacements led to slightly greater weight loss at 12 months only. Adding an additional intensive physical activity program provided longer-term and greater weight-loss increments than these dietary changes. Whether or not less intensive physical activity have this effect was unclear. Fitness approaches to weight loss may be of particular interest to men.
  5. Prescribing orlistat and continuing telephone or in-person contact for people following a weight loss program or weight maintenance led to additional weight loss over the weight loss program alone.
  6. Adding additional telephone or internet support, and group support, to a standard weight loss program was more effective than the weight loss program alone. There was weaker evidence to support CBT, motivational interviewing and mindfulness.
  7. Weight-management programs that were perceived to be novel or exciting and endorsed by health-care providers tended to be valued.
  8. Group-based program activities tended to be valued along with fairly intensive support from program providers.
  9. Weight-neutral interventions, without a focus on a calorie content or reduction, did not appear to be helpful for weight loss.

Last updated on 9/26/19.

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