From the ACP Diabetes Care Guide

This tool will help calculate patient body mass index (BMI).

open calculator

Provide counseling for pregnant women concerning gestational factors that can increase the risk of pregnancy and of unhealthy weight in their offspring.

Provide counseling and preventive strategies for children who are at risk for weight gain.

Provide counseling and preventive strategies for adults who are at risk for weight gain.

Advise patients to reduce BMI and central adiposity to decrease health risks and improve quality of life, especially in patients with BMI ≥30 kg/m2.

read more

Consider behavioral therapy with diet and exercise in overweight patients who need or want to lose weight.

Consider surgical treatment for very obese patients in whom other measures have failed.

read more

Consider drug therapy for patients with a BMI ≥30 kg/m2, or ≥27 kg/m2 with comorbidities such as hypertension, diabetes, or dyslipidemia.

Recognize that OTC herbal preparations sold for weight loss have limited efficacy and safety data.

read more

Provide realistic weight loss goals.

Recommend techniques to help patients adhere to lifestyle changes.

Counsel patients on adherence to drug therapy.

read more

From the ACP Diabetes Care Guide

Medical Nutrition Therapy

• The Plate Method
• Healthy Food Choices
• Basic Carbohydrate Counting
• Advanced Carbohydrate Counting
• Helping Patients Succeed with Meal Planning

Physical Activity

• Lifetime Physical Activity Model
• 10,000 Steps
• Planned Aerobic Exercise Programs
• Anaerobic Exercise Programs
• Helping Patients Succeed with Exercise Plans
  • What are some guidelines I can give patients to help them exercise safely?
  • How should I tell my patients to manage hypoglycemia during exercise?
  • What should I ask my patients at each visit to assess how they are doing with regard to physical activity?
  • Can I provide tips to help patients stay more faithful to their exercise plans?

NOTE: You may order free copies of the complete ACP Diabetes Care Guide (book and CD-ROM).

open document (pdf)

From the ACP Diabetes Care Guide

Obesity significantly increases the risk of developing type 2 diabetes, and the health consequences of obesity are more severe among patients with diabetes. In particular, central obesity is independently associated with insulin resistance and increased cardiovascular risk.

Topics in this chapter include:

• Classification of Obesity
• Helping Your Patients Lose Weight (Dietary Interventions, Pharmacologic Approaches, Surgical Approaches)

NOTE: You may order free copies of the complete ACP Diabetes Care Guide (book and CD-ROM).

SPECIAL NOTE: Page 75 has been revised.

open document (pdf)

Learn methods of approach in the management of obesity and hypertension in diabetic patients.

Learn preventive strategies to combat this problem in different areas of the world.

Learn about the prevalence and epidemiology of diabetes and obesity globally.

play presentation | download audio (mp3)

This session answers the following questions:

• What dietary approach really work?
• Pharmacology treatment in the obese type 2 diabetic
• Bariatric surgery: Who to treat and what to do after?

play presentation | download audio (mp3)

This session answers the following questions:

• What are the commonly available, advertised diets that our patients are trying?
• How do these diets work, and how much do they cost?
• Are there contraindications or risks associated with any of the diets?
• Which diets accomplish what outcomes?
• Are any commercial weight loss programs better or worse than others?

play presentation | download audio (mp3)

The American College of Physicians currently considers patients with a body mass index (BMI) >30 as obese, and those with a BMI between 25 and 29.9 as overweight.

The recently published Dietary Guidelines for Americans 2005 recommend at least 60 minutes per day of moderate activity for the prevention of weight gain and up to 90 minutes per day of moderate activity for weight reduction.

Physical activity and fitness reduce morbidity and mortality for coronary artery disease, hypertension, obesity, diabetes, and osteoporosis.

Note: Subscription to MKSAP 14 is required to view this material. For more information, visit www.acponline.org.

read more

Background:
Low-carbohydrate diets remain popular despite a paucity of scientific evidence on their effectiveness.

Objective:
To compare the effects of a low-carbohydrate, ketogenic diet program with those of a low-fat, low-cholesterol, reduced-calorie diet.

Design:
Randomized, controlled trial.

Setting:
Outpatient research clinic.

Participants:
120 overweight, hyperlipidemic volunteers from the community.

Intervention:
Low-carbohydrate diet (initially, <20 g of carbohydrate daily) plus nutritional supplementation, exercise recommendation, and group meetings, or low-fat diet (<30% energy from fat, <300 mg of cholesterol daily, and deficit of 500 to 1000 kcal/d) plus exercise recommendation and group meetings.

Measurements:
Body weight, body composition, fasting serum lipid levels, and tolerability.

Results:
A greater proportion of the low-carbohydrate diet group than the low-fat diet group completed the study (76% vs. 57%; P = 0.02). At 24 weeks, weight loss was greater in the low-carbohydrate diet group than in the low-fat diet group (mean change, -12.9% vs. -6.7%; P < 0.001). Patients in both groups lost substantially more fat mass (change, -9.4 kg with the low-carbohydrate diet vs. -4.8 kg with the low-fat diet) than fat-free mass (change, -3.3 kg vs. -2.4 kg, respectively). Compared with recipients of the low-fat diet, recipients of the low-carbohydrate diet had greater decreases in serum triglyceride levels (change, -0.84 mmol/L vs. -0.31 mmol/L [-74.2 mg/dL vs. -27.9 mg/dL]; P = 0.004) and greater increases in high-density lipoprotein cholesterol levels (0.14 mmol/L vs. -0.04 mmol/L [5.5 mg/dL vs. -1.6 mg/dL]; P < 0.001). Changes in low-density lipoprotein cholesterol level did not differ statistically (0.04 mmol/L [1.6 mg/dL] with the low-carbohydrate diet and -0.19 mmol/L [-7.4 mg/dL] with the low-fat diet; P = 0.2). Minor adverse effects were more frequent in the low-carbohydrate diet group.

Limitations:
We could not definitively distinguish effects of the low-carbohydrate diet and those of the nutritional supplements provided only to that group. In addition, participants were healthy and were followed for only 24 weeks. These factors limit the generalizability of the study results.

Conclusions:
Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet.

read more

A new study of published literature that reported the effect of dietary counseling for weight loss finds that, on average, dietary counseling has resulted in weight loss of approximately 6 percent of initial body weight (approximately 10-15 pounds) after one year, compared with people not involved in formal weight loss programs.

Approximately half the weight loss remained at three years, but almost none of the weight loss remained at five years. The study, "Meta-analysis: Effect of Dietary Counseling for Weight Loss," appears in the July 3, 2007, issue of Annals of Internal Medicine.

read more

How does someone decide whether to have a salad or ice cream with lunch? How do cancer patients choose between different courses of chemotherapy? While these questions vary greatly in their difficulty and significance, the key to understanding how people answer them lies in a still-developing field called behavioral economics.

"Behavioral economics brings together psychology and economics to better understand how people make decisions," said Kevin Volpp, ACP Member, assistant professor of medicine and health care systems at the University of Pennsylvania School of Medicine and the Wharton School in Philadelphia. The field grew out of some economists' recent realization that, contrary to traditional economic theory, people do not always make rational decisions or choose the course of action that is in their long-term interests.

read more

Gastric band surgery results in significantly more remission of type 2 diabetes than conventional therapy, according to the first randomized trial to compare the two treatments. It was also the first study to document the results of surgery in diabetics with BMIs of less than 35, the usual threshold for recommending bariatric surgery.

The authors of the study were guarded in their recommendations, and although they concluded that the study provided strong evidence for surgically induced weight loss for treatment of obese patients with diabetes, they also cautioned that the results need to be confirmed in a larger, more diverse population over a longer term.

read more

SAN FRANCISCO - Diabetes and testosterone studies topped the news at ENDO 08, the Endocrine Society's 90th annual meeting held last week. Among the research of interest to internists:

• Women with type 2 diabetes and heart disease get less intensive medical treatment for, and have poorer control of, these two conditions than men. In a study of nearly 45,000 diabetics, the comorbid women were 44% more likely than the comorbid men to have high LDL, but 15% less likely to get lipid-lowering medication. The women were also 19% more likely to have uncontrolled hypertension, and 15% more likely to have poor long-term control of their blood glucose levels. The findings may explain why death from heart disease has decreased among diabetic men in the past 25 years, but hasn't decreased for diabetic women, the study's lead author said.
• For obese and overweight men with type 2 diabetes, moderate fitness levels lowered the risk of all-cause death by 40%-50% during an average follow-up of seven years. By measuring peak metabolic rate during a standard treadmill exercise tolerance test, researchers classified fitness levels as low, moderate or high. Moderate fitness reduced death risk by 40% in healthy-weight and overweight men, and 52% in obese men, while high fitness level reduced death risk by 60% in healthy-weight men, and 65% in overweight men. The results suggest all diabetics, regardless of weight, should achieve and maintain at least a moderate fitness level, a study co-author said.

read more

The ADA has issued their 2008 Comprehensive Guidelines for Diabetes Care

read more

Question
Does laparoscopic adjustable gastric banding (LAGB) improve glycemic control more than conventional therapy (CT) alone in obese patients with recently diagnosed type 2 diabetes?

Conclusion
Laparoscopic adjustable gastric banding improved glycemic control more than conventional therapy alone in obese patients with recently diagnosed type 2 diabetes.

read more | printable PDF

Question
In overweight or obese adults who have recently lost weight, do weight-loss maintenance interventions reduce weight regain?

Conclusions
In overweight or obese adults who had recently lost weight, a personal-contact weight-loss maintenance intervention reduced weight regain more than a self-directed control condition. An Internet intervention provided early but transient benefit.

read more | printable PDF

Question
In adults, do statins prevent stroke and reduce mortality?

Conclusion
Statins prevent all strokes and reduce all-cause mortality.

read more | printable PDF

Question
In older men, do measures of adiposity and muscle mass predict mortality?

Conclusion
In older men, the combination of midarm muscle circumference and waist circumference best predicted mortality.

read more | printable PDF

Question
In older adults, do measures of adiposity and cardiorespiratory fitness predict mortality?

Conclusion
In older adults, body mass index and cardiorespiratory fitness were predictors of mortality.

read more | printable PDF

Question
In middle-aged women, what is the association between body mass index (BMI) and cancer incidence and mortality?

Conclusions
In middle-aged women, increasing body mass index was associated with increasing risk for cancer incidence and mortality overall. High body mass index increased risk for some types of cancer but reduced risk for other types.

read more | printable PDF

Question
In overweight or obese persons, what is the long-term efficacy of antiobesity drugs (AODs) for reducing weight and improving health status?

Conclusion
Orlistat, sibutramine, and rimonabant reduce weight and improve some health measures in overweight and obese persons.

read more | printable PDF

Question
In obese patients with type 2 diabetes mellitus, is a portion-control (PC) plate effective for weight loss?

Conclusion
A portion-control plate was effective for weight loss and decreased use of hypoglycemic medication in obese patients with type 2 diabetes mellitus.

read more | printable PDF

Question
Which measures of adiposity in middle-aged adults best predict mortality?

Conclusions
The highest levels of all measures of adiposity predicted increased mortality for men. For women, measures of central adiposity were better predictors of mortality than measures of overall adiposity.

read more | printable PDF

Question
In obese patients with knee osteoarthritis (OA), does weight loss reduce pain and improve functional disability?

Conclusion
Moderate weight loss improves functional disability but does not reduce pain in obese patients with knee osteoarthritis.

read more | printable PDF

Question
In women 65 years of age, what is the association between measures of body composition and mortality?

Conclusions
In women 65 years of age, those with the highest values for measures of body composition did not have increased risk for mortality compared with women with the lowest values. Women in the intermediate ranges (e.g., BMI 23.4 to 29.8 kg/m2) had reduced mortality compared with the leanest women.

read more | printable PDF

Question
In patients with mild-to-moderate obesity, is laparoscopic gastric band (LGB) surgery more effective than a nonsurgical diet and lifestyle intervention for promoting weight loss?

Conclusion
In patients with mild-to-moderate obesity, laparoscopic gastric band surgery was more effective than a nonsurgical diet and lifestyle intervention for weight loss and improvement of the metabolic syndrome and in quality of life.

read more | printable PDF

Question
Is being obese or overweight associated with an increased risk for end-stage renal disease (ESRD)?

Conclusion
Being overweight or obese was associated with an increased risk for end-stage renal disease in community-dwelling men and women.

read more | printable PDF

Question
In persons with impaired glucose tolerance, does an intensive lifestyle intervention (ILS) or treatment with metformin plus standard lifestyle recommendations prevent onset or promote resolution of the metabolic syndrome?

Conclusions
In persons with impaired glucose tolerance, an intensive lifestyle intervention or treatment with metformin plus standard lifestyle recommendations was more effective than standard lifestyle recommendations alone for preventing or delaying onset of the metabolic syndrome. Also, the intensive lifestyle intervention was more effective than metformin for preventing the metabolic syndrome.

read more | printable PDF

Question
What is the evidence that pharmacologic therapies can prevent type 2 diabetes mellitus?

Conclusion
In patients with type 2 diabetes mellitus, some oral hypoglycemic agents and antiobesity drugs reduce the incidence of diabetes, but the findings are inconsistent and many studies have low patient follow-up or show high drug-related gastrointestinal adverse effects.

read more | printable PDF

Question
How effective and safe are pharmacologic therapies in the treatment of obesity?

Conclusion
On average, sibutramine, phentermine, orlistat, diethylpropion, bupropion, topiramate, and fluoxetine led to 1 to 7 kg of weight loss by 6 months in obese adults with body mass index 27 kg/m2.

read more | printable PDF

Question
How effective and safe are surgical treatments for obesity?

Conclusion
Evidence, mostly from observational studies, suggests that surgical treatment of obesity is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with body mass index 40 kg/m2.

read more | printable PDF

Question
What is the efficacy of major commercial or organized self-help weight loss programs that provide structured in-person or online counseling?

Conclusions
1 of 5 randomized controlled trials showed that a nonmedical commercial weight loss program (Weight Watchers) was modestly effective in achieving long-term weight loss. Little evidence supports the efficacy of commercial and self-help weight loss programs.

read more | printable PDF

Question
In obese patients with type 2 diabetes mellitus, is a registered dietitian–led case management (RDCM) intervention more effective than usual care (UC) for improving health indicators?

Conclusion
In obese patients with type 2 diabetes mellitus, a registered dietitian–led case management intervention was better than usual care for reducing weight, waist circumference, use of prescription medications, and improved health-related quality of life.

read more | printable PDF

Question
In patients with type 2 diabetes mellitus, what is the efficacy of pharmacotherapy for weight loss?

Conclusion
In patients with type 2 diabetes mellitus, fluoxetine, orlistat, and sibutramine modestly reduce weight and fluoxetine and orlistat improve blood sugar control.

read more | printable PDF

Question
What is the effectiveness of antiobesity medications in trials with 1-year follow-up?

Conclusion
Orlistat and sibutramine are modestly effective for weight loss at 1 year.

read more | printable PDF

Question
In adults in the outpatient setting, how effective are lower- vs higher-carbohydrate diets?

Conclusions
In adults in the outpatient setting, lower-carbohydrate diets do not result in greater weight loss than higher-carbohydrate diets. More rigorous studies are needed to show the efficacy and safety of lower-carbohydrate diets.

read more | printable PDF

Question
In persons who are overweight or clinically obese and who are dieting for the purpose of weight reduction, is advice on low-fat diets more effective than other weight-reducing diets for achieving sustained weight loss?

Conclusion
In persons who are overweight or clinically obese and who are dieting for the purpose of weight reduction, advice on low-fat diets is not better than other weight-reducing diets for achieving sustained weight loss.

read more | printable PDF

Question
In obese persons, is sibutramine effective for reducing weight?

Conclusion
In obese persons, continuous or intermittent sibutramine were equally effective for reducing weight.

read more | printable PDF

Questions

Conclusions
Placebo is more effective than no treatment for continuous subjective outcomes and for treatment of pain. Placebo and no treatment do not differ in trials assessing objective or subjective binary outcomes or objective continuous outcomes.

read more | printable PDF

Question
What is the effectiveness of orlistat for weight loss and coronary artery disease risk factor reduction in persons who are obese and have 1 coronary risk factor?

Conclusion
Treatment with orlistat combined with a mildly hypocaloric diet was safe and more effective than diet alone for weight loss and coronary heart disease risk factor reduction in persons who are obese and have high coronary risk.

read more | printable PDF

This guideline is based on the evidence report and accompanying background papers developed by the Southern California Evidence-Based Practice Center. The American College of Physicians nominated this topic to the Agency for Healthcare Research and Quality Evidence-Based Practice Center program as part of a concerted effort to complement the guidelines of the U.S. Preventive Services Task Force. The College recommends that all clinicians refer to the Task Force recommendations as part of an overall strategy for managing overweight and obesity, which should always include appropriate diet and exercise for all patients who are overweight or obese. The intent of this guideline is to provide recommendations based on a review of the evidence on pharmacologic and surgical treatments of obesity. The target audience is all clinicians caring for obese patients, defined as a body mass index of 30 kg/m² or greater. This guideline is not intended to be used by commercial weight loss centers or for direct-to-consumer marketing by manufacturers and does not apply to patients with body mass indices below 30 kg/m².

*This paper, written by Vincenza Snow, MD; Patricia Barry, MD, MPH; Nick Fitterman, MD; Amir Qaseem, MD, PhD, MHA; and Kevin Weiss, MD, MPH, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Kevin Weiss, MD, MPH (Chair); Mark Aronson, MD; Patricia Barry, MD, MPH; Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Nick Fitterman, MD; E. Rodney Hornbake, MD; Douglas K. Owens, MD; and Katherine D. Sherif, MD. Approved by the ACP Board of Regents in October 2004.

read more | printable PDF

Background:

In response to the increase in obesity, pharmacologic treatments for weight loss have become more numerous and more commonly used.

Purpose:

To assess the efficacy and safety of weight loss medications approved by the U.S. Food and Drug Administration and other medications that have been used for weight loss.

Data Sources:

Electronic databases, experts in the field, and unpublished information.

Study Selection:

Up-to-date meta-analyses of sibutramine, phentermine, and diethylpropion were identified. The authors assessed in detail 50 studies of orlistat, 13 studies of fluoxetine, 5 studies of bupropion, 9 studies of topiramate, and 1 study each of sertraline and zonisamide. Meta-analysis was performed for all medications except sertraline, zonisamide, and fluoxetine, which are summarized narratively.

Data Extraction:

The authors abstracted information about study design, intervention, co-interventions, population, outcomes, and methodologic quality, as well as weight loss and adverse events from controlled trials of medication.

Data Synthesis:

All pooled weight loss values are reported relative to placebo. A meta-analysis of sibutramine reported a mean difference in weight loss of 4.45 kg (95% CI, 3.62 to 5.29 kg) at 12 months. In the meta-analysis of orlistat, the estimate of the mean weight loss for orlistat-treated patients was 2.89 kg (CI, 2.27 to 3.51 kg) at 12 months. A recent meta-analysis of phentermine and diethylpropion reported pooled mean differences in weight loss at 6 months of 3.6 kg (CI, 0.6 to 6.0 kg) for phentermine-treated patients and 3.0 kg (CI, −1.6 to 11.5 kg) for diethylpropion-treated patients. Weight loss in fluoxetine studies ranged from 14.5 kg of weight lost to 0.4 kg of weight gained at 12 or more months. For bupropion, 2.77 kg (CI, 1.1 to 4.5 kg) of weight was lost at 6 to 12 months. Weight loss due to topiramate at 6 months was 6.5% (CI, 4.8% to 8.3%) of pretreatment weight. With one exception, long-term studies of health outcomes were lacking. Significant side effects that varied by drug were reported.

Limitations:

Publication bias may exist despite a comprehensive search and despite the lack of statistical evidence for the existence of bias. Evidence of heterogeneity was observed for all meta-analyses.

Conclusions:

Sibutramine, orlistat, phentermine, probably diethylpropion, bupropion, probably fluoxetine, and topiramate promote modest weight loss when given along with recommendations for diet. Sibutramine and orlistat are the 2 most-studied drugs.

read more | printable PDF

Background:

Controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in health-related outcomes.

Purpose:

To perform a meta-analysis of effectiveness and adverse events associated with surgical treatment of obesity.

Data Sources:

MEDLINE, EMBASE, Cochrane Controlled Trials Register, and systematic reviews.

Study Selection:

Randomized, controlled trials; observational studies; and case series reporting on surgical treatment of obesity.

Data Extraction:

Information about study design, procedure, population, comorbid conditions, and adverse events.

Data Synthesis:

The authors assessed 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. The authors identified 1 large, matched cohort analysis that reported greater weight loss with surgery than with medical treatment in individuals with an average body mass index (BMI) of 40 kg/m² or greater. Surgery resulted in a weight loss of 20 to 30 kg, which was maintained for up to 10 years and was accompanied by improvements in some comorbid conditions. For BMIs of 35 to 39 kg/m², data from case series strongly support superiority of surgery but cannot be considered conclusive. Gastric bypass procedures result in more weight loss than gastroplasty. Bariatric procedures in current use (gastric bypass, laparoscopic adjustable gastric band, vertical banded gastroplasty, and biliopancreatic diversion and switch) have been performed with an overall mortality rate of less than 1%. Adverse events occur in about 20% of cases. A laparoscopic approach results in fewer wound complications than an open approach.

Limitations:

Only a few controlled trials were available for analysis. Heterogeneity was seen among studies, and publication bias is possible.

Conclusions:

Surgery is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 kg/m² or greater. More data are needed to determine the efficacy of surgery relative to nonsurgical therapy for less severely obese people. Procedures differ in efficacy and incidence of complications.

read more | printable PDF

Obesity is a major risk factor for heart disease. In the face of obesity's growing prevalence, it is important for physicians to be aware of emerging research of novel mechanisms through which adiposity adversely affects the heart. Conventional wisdom suggests that either hemodynamic (that is, increased cardiac output and hypertension) or metabolic (that is, dyslipidemic) derangements associated with obesity may predispose individuals to coronary artery disease and heart failure. The purpose of this review is to highlight a novel mechanism for heart disease in obesity whereby excessive lipid accumulation within the myocardium is directly cardiotoxic and causes left ventricular remodeling and dilated cardiomyopathy. Studies in animal models of obesity reveal that intracellular accumulation of triglyceride renders organs dysfunctional, which leads to several well-recognized clinical syndromes related to obesity (including type 2 diabetes). In these rodent models, excessive lipid accumulation in the myocardium causes left ventricular hypertrophy and nonischemic, dilated cardiomyopathy. Novel magnetic resonance spectroscopy techniques are now available to quantify intracellular lipid content in the myocardium and various other human tissues, which has made it possible to translate these studies into a clinical setting. By using this technology, we have recently begun to study the role of myocardial steatosis in the development of obesity-specific cardiomyopathy in humans. Recent studies in healthy individuals and patients with heart failure reveal that myocardial lipid content increases with the degree of adiposity and may contribute to the adverse structural and functional cardiac adaptations seen in obese persons. These studies parallel the observations in obese animals and provide evidence that myocardial lipid content may be a biomarker and putative therapeutic target for cardiac disease in obese patients.

read more | printable PDF

Background:

Dietary and lifestyle modification efforts are the primary treatments for people who are obese or overweight. The effect of dietary counseling on long-term weight change is unclear.

Purpose:

To perform a meta-analysis of the effect of dietary counseling compared with usual care on body mass index (BMI) over time in adults.

Data Sources:

Early studies (1980 through 1997) from a previously published systematic review; MEDLINE and the Cochrane Central Register of Controlled Trials from 1997 through July 2006.

Study Selection:

English-language randomized, controlled trials (≥16 weeks in duration) in overweight adults that reported the effect of dietary counseling on weight. The authors included only weight loss studies with a dietary component.

Data Extraction:

Single reviewers performed full data extraction; at least 1 additional reviewer reviewed the data.

Data Synthesis:

Random-effects model meta-analyses of 46 trials of dietary counseling revealed a maximum net treatment effect of −1.9 (95% CI, −2.3 to −1.5) BMI units (approximately −6%) at 12 months. Meta-analysis of changes in weight over time (slopes) and meta-regression suggest a change of approximately −0.1 BMI unit per month from 3 to 12 months of active programs and a regain of approximately 0.02 to 0.03 BMI unit per month during subsequent maintenance phases. Different analyses suggested that calorie recommendations, frequency of support meetings, inclusion of exercise, and diabetes may be independent predictors of weight change.

Limitations:

The interventions, study samples, and weight changes were heterogeneous. Studies were generally of moderate to poor methodological quality. They had high rates of missing data and failed to explain these losses. The meta-analytic techniques could not fully account for these limitations.

Conclusions:

Compared with usual care, dietary counseling interventions produce modest weight losses that diminish over time. In future studies, minimizing loss to follow-up and determining which factors result in more effective weight loss should be emphasized.

read more | printable PDF