Lisa Wehr's Public Health Blog

Lisa is originally from Sigourney, Iowa. She attended Iowa State University and received her bachelor’s degree in Music in 2010. She is currently a first year Master’s of Public Health (MPH) student in community and behavioral health (CBH). Lisa works on the medicine-psychiatry unit at the University of Iowa Hospitals and Clinics (UIHC). Through this blog Lisa hopes to let people learn about the CBH department.

This student blog is unedited and does not necessarily reflect the views of the College of Public Health or the University of Iowa.

19 December 2010

Weight Loss Programs and Insurance

Another set of two articles to ponder.

The first comes from the Consumer Reports Health Blog: Commercial Weight-Loss Programs: The Evidence

The second comes from Dr. Judith Wurtman on the Huffington Post: Weight Loss: Should Commercial Programs be Covered by Health Insurance?

It's one of those never-ending battles: do weight-loss programs actually work? Some say they do, some say they don't, others say they only work short-term or never allow the participants to have a "normal" food life without gaining all the weight back. And what is the scientific evidence for them? Strangely, there have been very few studies. The blog post from Consumer Reports looks at two recent studies in the Journal of the American Medical Association (JAMA) that looked at lifestyle interventions and prepared meals to help with weight-loss.

The first study lasted one year and split the participants into two groups. The first group had diet and physical activity interventions for the full year, the second group started with just a diet intervention and started physical activity six months later. The results? The group that did both diet and exercise initially had a greater weight-loss at the six-month mark, but after adding exercise, both groups had similar weight loss at the twelve-month mark.

I'm not sold on the study design. I think delaying the exercise in one group, but still having both groups do it, confounds the results. The initial intention wasn't to determine if delaying exercise had any effect on weight loss; it was looking at the efficacy of diet and exercise interventions. If I were planning this study I would have one group with only a diet intervention, one group with only a physical activity intervention, and one group with both interventions. This would (hopefully) allow the researchers to determine which type of intervention, or combination of interventions, was most effective.

So a structured diet and exercise plan works, and helps the participants keep the weight off for at least a year. What about the other study? This study was looking at the effect of pre-packaged meals as part of a structured weight-loss program (this study was funded by Jenny Craig). It compared two groups: one that received ongoing support in addition to prepackaged meals during the initial weight loss, the other group received standard obesity counseling and monthly "contact." The group that received meals and structured support had greater, sustained weight loss.

I like a couple things about this study. First, I like that the two groups were clearly defined; there wasn't any crossing-over with their interventions. Second, a two year follow-up gives a better picture of whether the intervention worked in the long-term. I'm not necessarily a fan of prepackaged meals. I question whether people would actually follow the program if they had to pay the inflated price for all of these meals (the study participants received them for free). And I don't like the idea that people aren't taught the principles of feeding themselves with real, fresh food. I'll be honest, I'm not familiar with the Jenny Craig plans and their prepackaged meals. Perhaps participants are taught the basics of good nutrition, maybe they do learn what to prepare for themselves after the packaged phase. But I'm hesitant. Will these people become reliant on a company to tell them what to eat to stay "healthy" (read: thin). Will they trust their own instincts on feeding themselves? What lessons are they passing on to their children with this? And there are a few bigger issues: the disparity created by those who can't afford these programs and concerns related  to packaged foods. I worry about added salt, sugar, preservatives, and the loss of the concept of real food. (I would love to go on about my views of nutrition, health, weight, and food, but that is best left for another post...or series of posts)

And what to do with this information? This is where the second article I linked to heads: should insurance companies cover weight-loss programs? Insurers are willing to shell out big bucks for obesity drugs and surgeries. Why? Because obesity costs them. And why won't these same companies pay for commercial programs? I'm at a loss there. It appears that it is a cheaper, effective alternative (probably not as effective as surgery, but one could argue that it is more cost-effective). I wonder if the companies see less weight loss as less healthy. I personally think fitness is preferable to thinness and I would presume that diet/exercise programs would achieve that better than surgery. It's an argument that could go around and around.




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