Medical Weight Loss

Americans spend over $100 billion each year in medical weight loss.  This industry is big business in the U.S. and fraught with false claims and inaccuracies.  This is an area where those seeking help are routinely mislead and set up for failure and disappointment, only further accelerating the downward spiral of morbid obesity.

Below is a brief description of all of the different categories of medical weight loss, along with some information as to its effectiveness in treating this disease. Most medical weight loss programs are based on some combination of caloric restriction (diets), increased caloric output (exercise), counseling and support (behavior modification), and possibly pharmacotherapy (medications).

Diets

There are literally hundreds of diets available ranging from medically supervised and scientifically formulated (Optifast, Physicians Weight Loss) to structured yet unsupervised (Weight Watchers, Jenny Craig, NutriSystem) to self-directed (Adkins, South Beach) and fads (cabbage soup diet).

These generally have similar goals of restricting caloric intake while maintaining nutrition and fall into two basic categories:

  1. Low calorie diets (LCDs), usually consisting of 1,200-1,500 calories per day (Weight Watchers, Jenny Craig, NutriSystem).
  2. Very low calories diets (VLCDs), typically limiting caloric intake to 400-800 calories per day (Optifast, Medifast, Physicians Weight Loss Center), and feature high protein low fat liquids.

In general, VLCDs produce greater initial weight loss than LCDs.  Unfortunately, despite the multitude of options and strategies offered, no single plan has ever been demonstrated to produce significant, much less sustained, weight loss, especially with morbid obesity.  In general, weight loss experience ranges from 5-10% initially and is re-gained in 95-100% of subjects within 1-2 years.

In 2005, a systematic review of the available data on all the major commercially available weight loss programs was conducted by the University of Pennsylvania.  This included programs such as Weight Watchers, Jenny Craig, Optifast, Medifast, Tops, eDiets and Overeaters Anonymous.  Several conclusions were made.  First, there are very few control studies of most programs.  Second, of those studies found, weight loss was minimal.  Further, these programs were associated with high cost, high attrition (drop out) rates and high probability of weight regain.

The author concluded that “the evidence is inadequate to recommend commercial or self-help programs”.  Essentially, these dietary programs, albeit very popular, have been shown to be ineffective for the vast majority of dieters.  It should be clear that there is no available evidence to show that for one with morbid obesity, any medical dietary therapy will be success in achieving adequate and sustained weight loss.

Exercise

In addition to caloric restriction, increasing energy expenditure is a basic tenant to affect weight loss.  This is generally done through recommending regular exercise.  As with diet, Americans spend billions of dollars each year on a multitude of exercise programs to affect weight loss.  This is an area that is especially intimidating and difficult for those suffering morbid obesity.

A National Institutes of Health evaluation of 13 studies concluded that physical activity:

  • Results in modest  weight loss in overweight and obese individuals.
  • Increased cardiovascular fitness, even when there is no weight loss.
  • Is very helpful in maintaining weight loss.

Diet plus exercise has clearly been shown to produce more weight loss than exercise alone.

Further, new theories focusing on the body’s set point (see Causes of Obesity/Metabolism) underscore the importance of exercise when dieting.  When you reduce the amount of calories consumed, the body reacts by burning fewer calories.  Daily exercise speeds up the metabolism, offsetting this effect.  However, it is important to understand that the increase in metabolism is dependent on both the length and intensity of the bout of exercise and lasts, at best, about 12-24 hours.  Therefore, daily rigorous exercise is an essential component to weight loss and maintenance.

This continues to be one of the most difficult areas in treating morbid obesity, both medically and surgically, as consistent exercise has been shown time and time again to be the most challenging habit to maintain.  Conversely, daily exercise has consistently been shown to be a habit of those who maintain weight loss long term, with or without surgery.

Indeed, according to the National Weight Loss Registry, 75% of those who lose weight and keep it off long term exercise an hour every day.

That being said, as with dieting, the data concerning exercise for weight loss show a modest benefit and at best outside of the context of weight loss surgery.

Medications

Hundreds of over the counter and prescription drugs have been introduced, claiming to affect weight loss.  Most of these work by one of two mechanisms.  They either affect the brain to suppress appetite, or work within the GI tract to decrease fat absorption.

Regardless of the mechanism, controlled studies have shown that patients on drug therapy lose around 10% of their excess weight, and this plateaus after 6-8 months.  When medication is stopped, weight gain usually occurs.  These medications may have a role in helping those who need to lose 10-20 pounds, but have essentially no role in treating morbid obesity.  Once again, it is profoundly clear in the medical literature that there is no medication, either past, present or on the horizon that has any role in treating morbid obesity long term, and is essentially a complete waste of money and effort.

Summary

In summary, the available data demonstrates that all forms of medical weight loss, be it diet, exercise, medications or a combination of these produce around 10% excess weight loss on average, or about 10-30 pounds for those with morbid obesity.  Further, about 95% of individuals will gain that weight back within 1-2 years.  The natural history of morbid obesity demonstrates progressive annual weight gain, so most gain back even more than that which was lost, perpetuating the downward spiral of morbid obesity.  Given this, it is difficult to conclude that medical weight loss for morbid obesity is anything less than a complete failure in all but the most rare of circumstances.

Morbid obesity is a complex, multi-factorial chronic disease. Clearly, anything less than radical and permanent transformation will only result in failure to treat this process.

According to the New England Journal of Medicine:  “Since many people cannot lost weight, no matter how hard they try, and promptly regain whatever was lost, the vast amount of money spent on diet clubs, special foods, and over the counter remedies, estimated to be in the order of $30 billion to $50 billion yearly, is wasted”.