All alone and the diet’s not working
When it comes to dieting, the do-it-yourself approach might not be the best way to go -- at least when it comes to keeping the weight off.
In studying the nation’s largest commercial weight-loss program, researchers found that those who adhered to the plan managed to keep off more weight than those who tried to drop the pounds on their own.
Granted, the difference wasn’t huge. Participants in the plan, Weight Watchers, kept off an average of 6 pounds after two years. But those who tried going it alone after two sessions with a nutritional counselor ended up back where they started.
“Diets don’t fail. People don’t adhere to diets,” said lead study author Stanley Heshka, a research associate at the New York Obesity Research Center at St. Luke’s Roosevelt Hospital in New York City. “Wanting is not enough. You need a structured program that will help you adhere to the diet.”
Researchers at half a dozen medical centers randomly assigned nearly 400 overweight and obese people to either local Weight Watchers programs or to self-help plans, then monitored them for two years. In the structured program, dieters dropped an average of 10 pounds in the first year, and gained back less than half of that at the end of two years.
The self-helpers, some of whom tried diet pills, herbal products, high-protein or other diets, lost about 3 pounds in the first year. But in the second year, they “found” those lost pounds.
Because the researchers didn’t study individual elements of the commercial program, Heshka was unable to say whether group support, an exercise plan, tracking daily eating or limiting meals to a set number of “points” based on fat, fiber and calories -- accounted for the lost pounds. But, he said, previous studies have shown that “just asking you to write down everything you eat provides weight loss.”
Lest the self-guided plan be written off as valueless, he noted that at least those dieters “hadn’t gained weight. The tendency in adulthood from age 20 to 60, is to gain about half a pound to a pound a year.”
Dr. George Blackburn, associate director of the nutrition division at Harvard Medical School, says a key to losing weight is following a structured plan. Although many dieters also succeed in group programs such as Overeaters Anonymous and Jenny Craig, Blackburn noted that those haven’t been put through rigorous scientific comparison studies such as Heshka’s, the first to put Weight Watchers to a long-term test.
The study found a clear relationship between pounds lost and meeting attendance. Those who made it to three-quarters or more of the weekly meetings dropped an average of 12 pounds at the first year’s end and kept off 10 to 11 pounds after two years.
Those who appeared for half to three-quarters of the meetings lost an average of 10 pounds after a year and maintained a 9-pound loss. Those who showed up at fewer than half the meetings lost 7 pounds in the first year and maintained a 5-pound loss.
Heshka said that a dieter’s ability to get the same results without the program would depend on access to support groups and behavior therapy. He said motivation is key and that many of the most compliant study subjects lost significant amounts of weight.
Penny Edwards, a certified nutrition specialist in Northern California, said exercise is key to any weight-loss plan. “That’s the one element that people can really take control of themselves, whether they need to do it in a group setting or alone.”
Study participants, ages 18 to 65, each had a body mass index of 27 to 40. (A 5-foot-4 woman who weighs 157 has a BMI of 27; she’d have to weigh 232 pounds to have a BMI of 40).
Results of the study, funded by Weight Watchers International in Woodbury, N.Y., appear in the current issue of the Journal of the American Medical Assn.
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Research pushes on as obesity rates rise
The current issue of the Journal of the American Medical Assn. focuses on the growing rates of obesity in adults and children, with such health consequences as diabetes, high blood pressure and heart disease. Among the findings:
* The prescription diet drug sibutramine (Meridia), when combined with a weight-loss plan that stresses behavioral modification, can help overweight and obese teenagers lose pounds. In a six-month study of 82 adolescents, half of whom received the drug and half of whom got a dummy pill, those getting the medication lost more weight and reported significantly less hunger. However, the University of Pennsylvania researchers said increases in blood pressure and pulse rate would make it necessary to closely monitor effects of the drug and keep its use in teens experimental.
* The epilepsy drug zonasamide was better than a dummy pill in helping dieters lose weight in a study of 60 overweight women and men. At the end of the 16-week Duke University study, those getting the drug lost an average of 13 pounds, compared with 2 pounds among those getting the dummy pill. Researchers also noted that the medication reduced blood pressure, although none of the study participants had hypertension.
* Although it’s long been known that being sedentary contributes to obesity and diabetes, Harvard University researchers have established that for every two hours of daily television-watching, women have a 23% increase in obesity and a 14% increased risk for diabetes. That compared with a 24% reduction in obesity and 34% reduction in diabetes for every two hours of brisk walking. Dr. Frank B. Hu and his colleagues based their findings on 50,277 women who participated in the landmark Nurses’ Health Study.
* A new analysis of existing studies of low-carbohydrate diets like the popular Atkins plan has found insufficient evidence about their safety and usefulness to recommend them for weight loss. Dr. Dena M. Bravata of Stanford University and her colleagues said most of the existing studies were too short and the patients too young to draw broad conclusions. Despite the millions of Americans’ reported weight loss successes on low-carb diets, the authors said they couldn’t attribute the dropped pounds to restricting carbohydrates.
-- Jane E. Allen
