title: Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study.
abstract: OBJECTIVE
  There have been few randomized controlled trials of commercial weight-loss programs. This ongoing study compares the effects of a self-help program and a commercial program on weight loss and other measures of obesity in overweight and obese men and women.
  
  
  METHODS
  We report the results of the first 26 weeks of a multicenter, randomized, 2-year study of 423 subjects who had a body mass index of 27 to 40 kg/m(2). Subjects were randomly assigned to either a self-help program, consisting of two 20-minute sessions with a nutritionist and provision of printed materials and other self-help resources, or to attendance at meetings of a commercial program (Weight Watchers). Outcome measures were changes in body weight, body mass index, waist circumference, and body fat. Changes in serum homocysteine levels were measured in a subsample of participants during the first 12 weeks.
  
  
  RESULTS
  After 26 weeks, subjects in the commercial program, as compared with those in the self-help program, had greater decreases in body weight [mean (+/- SD) -4.8+/-5.6 vs -1.4+/-4.7 kg] and body mass index (-1.7+/-1.9 vs -0.5+/-1.6 kg/m(2), both P<0.001) in intention-to-treat analyses. Among subjects measured at week 26, mean waist circumference (-4.3+/-10.5 vs -0.7+/-12.7 cm) and fat mass (-3.8 +/-7.0 vs -1.5+/-7.6 kg, both P<0.05) also decreased more among subjects in the commercial program. Mean serum homocysteine levels improved in the commercial program compared with self-help (-0.5+/-1.3 vs 0.9+/-1.8 microM, P<0.05).
  
  
  CONCLUSIONS
  A structured commercial weight-loss program is more likely to be effective for managing moderately overweight patients than brief counseling and self-help.
authors.affiliation: New York Obesity Research Center (SH, XP), St. Luke's/Roosevelt Hospital and Columbia University, New York, New York 10025, USA.
authors.forename: S
authors.initials: S
authors.lastname: Heshka
authors.forename: F
authors.initials: F
authors.lastname: Greenway
authors.forename: J W
authors.initials: JW
authors.lastname: Anderson
authors.forename: R L
authors.initials: RL
authors.lastname: Atkinson
authors.forename: J O
authors.initials: JO
authors.lastname: Hill
authors.forename: S D
authors.initials: SD
authors.lastname: Phinney
authors.forename: K
authors.initials: K
authors.lastname: Miller-Kovach
authors.forename: F
authors.initials: F
authors.lastname: Xavier Pi-Sunyer
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016001:Confidence Intervals; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006293:Health Promotion; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D052756:Nutritional Sciences / Q000193:education*; D009765:Obesity / Q000097:blood / Q000178:diet therapy / Q000628:therapy*; D010358:Patient Participation; D015397:Program Evaluation; D012648:Self Care; D012680:Sensitivity and Specificity; D015431:Weight Loss
chemical_list: D006710:Homocysteine