Internal medicine

Population

Obesity

Nursing

Political science

Randomized controlled trial

Psychological intervention

Systematic review

MEDLINE

Overweight

Weight management

Weight loss

Gerontology

Medicine

Environmental health

Annals of Internal Medicine

Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear.To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults.MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff.Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only).Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias.We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs.Many trials were short (<12 months), had high attrition, and lacked blinding.Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed.None. (CRD4201-4007155).

Efficacy of Commercial Weight-Loss Programs