18. commercial products and programs in obesity management (complete)

Question 1

None of the weight loss products from the commercial
industry that were studied in randomized control trials of
more than 12 weeks duration were shown to produce clin
ically meaningful weight loss. (T/F)

Answer 1

T

Question 2

what are some commercial programs that combine nutrition, physical activity and support?

Answer 2

Jenny Craig, Nutrisystem, Optifast, WW (Weight Watchers)

Question 3

some commercial programs that combine nutrition, physical activity and support have shown improvement in which ? but no effect on which?

Answer 3

yes to glycemic control in patients with obesity and diabetes;
no effect on lipids or blood pressure

Question 4

For adults living with overweight or obesity, the following
commercial programs should achieve mild to moderate weight loss over the short or medium term, compared to usual care or education:

Answer 4

a) WW® (Weight Watchers): (Level 1a, Grade A);
b) Optifast®: (Level 1b, Grade B);
c) Jenny Craig® (Level 1b, Grade B); and
d) Nutrisystem® (Level 1b, Grade B).

Question 5

Optifast®, Jenny Craig®, WW® (formerly Weight Watchers)
and Nutrisystem® should achieve a mild reduction of glycated
hemoglobin values over a short-term period compared to what?

Answer 5

usual conselling in adults with obesity and type 2 diabetes (Level 1b, Grade B)

Question 6

would you recommend the use of over-the-counter com
mercial weight loss products for obesity management?

Answer 6

No - lack of evidence

Question 7

what to look for in a safe and successful obesity management program ?

Answer 7

• Behavioural counselling, including the use of food and activity
  records;
• Discussion around social determinants of health and their impact
  on weight;
• Discussion around the risks and benefits of medications for
  obesity management;
• Ongoing feedback, monitoring and support from the program;
• Weight loss goals of 0.5–1.0 kg weekly;
• A component specifically designed to address maintaining lost
  weight; and
• Long program durations.

Question 8

what are some commercially available weight lose pills or commercial products?

Answer 8

PGX, Garcinia cambogia, Green tea extract, Chromium picolinate, Chitosan, Conjugated linoleic acid, Glucomannan, Acupuncture, Cryolipolysis, Whole body vibration therapy

Question 9

what is PGX and what is the conclusion about use?

Answer 9

PGX - polyglycopleX - highly viscous fibre;
meta-analysis: no reduction in body weight, may cause reductions in total and LDL cholesterol.

Question 10

What is carcinia cambogia and conclusion about weight lose?

Answer 10

small fruit in Southern India - appetite control and more?
little evidence to support the use;
concern for liver toxicity

Question 11

what is green tea extract mechanism and use in weight loss?

Answer 11

polyphenols that increase energy expenditure and fat oxidation - not demonstrated clinical efficacy

Question 12

what is chromium picolinate and use for weight loss?

Answer 12

it is said to stimulate NTs responsible in eating behaviours - no current, reliable evidence to inform treatment decisions as to use or safety

Question 13

what is chitosan?

Answer 13

polysaccharide - thought to reduce the absorption of dietary fat from the GI.
led to 1.7kg greater weight loss, but not clinically significant.

Question 14

conjugated linoleic acid?

Answer 14

group of fatty acids that are produced naturally in the digestive tracts of ruminants, pigs, chickens, and turkeys.
reduced 0.52kg not clinically significant

Question 15

glucomannan?

Answer 15

soluble fibre - delay gastric emptying, increase satity and reduce dietary intake?
limited data to support it may help to reduce body weight, but not body mass index

Question 16

acupuncture?

Answer 16

1. acupucture + lifestyle modification –> more effective than lifestyle alone
2. acupuncture alone no more effective than sham acupuncture alone;
3. effective only with overweight, and not those with obesity

Question 17

cryolipolysis?

Answer 17

19.55% mean reduction of targeted subcutaneous tissue after 3.83 months of treatment, but that long-term follow-up data was lacking.

Question 18

whole body vibration therapy?

Answer 18

inconsistent and contradictory

Question 19

WW program vs. primary care brief intervention -12 weeks or 52 weeks result?

Answer 19

WW better weight loss at 12, 52 week, 12 months, 2 year follow- up

Question 20

WW vs. nurse-led clinical based weight loss intervention (12 wt loss counseling sessions over 17 weeks + meal replacement or pharmacotherapy)?

Answer 20

clinic-based more effective for weight loss (4kg vs 0.4kg)

Question 21

WW program vs. self-help program developed by the National Diabetes Education program –> effect on glycemic control, which is better?

Answer 21

WW has greater weight loss at 12 months, greater improvements in A1C and HDL

Question 22

WW program for type 2 diabetes, combined with telephone and email consultations with a certified diabetes educator vs. standard diabetes nutrition counseling and education - result?

Answer 22

WW greater weight loss, improved A1C, 26% reduced diabetes medication vs 12% in standard care group;
greated improvement in weight-related quality of life and a decrease in the diabetes distress score.

Question 23

cost-effectiveness review: WW vs. Jenny Craig or pharmacotherapy?

Answer 23

WW is favourable

Question 24

Qualitative studies have confirmed that patients view the WW® program as an appropriate and medically pertinent intervention for obesity management. WW® participants value the support and motivation, ease of access and frequent contact provided in this program. (T/F)

Answer 24

T

Question 25

what is Curves?

Answer 25

30 min resistance exercise circuit, 4 days per week + weekly personal coaching sessions

Question 26

was there any significant results for Curves?

Answer 26

one study 1.8kg more loss then WW at 3 months; no data about the efficacy for reduction of lipids, blood pressure or glucose

Question 27

what is Ideal Protein? any data for efficacy?

Answer 27

ketogenic meal replacement program; one-on-one coaching with healthcare practitioners or trained coaches, online coaching support; no data about efficacy, safety, or improvement of cardiometabolic risk factors

Question 28

what is Jenny Craig?

Answer 28

weekly individual lessons (telephone or face-to-face) with behavioural counseling, low-calorie or low-carb diet with prepackaged meals and an online tracking method for food journaling. 4.9% greater weight loss at 12 months; reduction of A1C by 0.4-0.8% greater than counselling at 12 months; Insulin was reduced or stopped in 8% in the counselling group as compared to 63% in the traditional Jenny Craig group.Oral meds decreased or stopped 16 vs 39% JC group; No glycemic outcomes results

Question 29

what is Nutrisystem?

Answer 29

counselling session, exercise plan, online tracking methods for food journaling, low-calorie diet with meal replacement

Question 30

Nutrisystem vs behavioural counseling result?

Answer 30

3.8% greater weight loss at 3 months; A1C 0.3% better at 6 months

Question 31

Nutrisystem vs Curves vs Jenny Craig ?

Answer 31

no program was shown to be superior regarding weight loss and waist circumference

Question 32

Optifast?

Answer 32

based in canada, medically supervised, high-intensity behavioural intervention program combined with a low-calorie meal replacement diet of 900 kcal per day. 6 months program, weekly meetings, 12 weeks of full meal replacement

Question 33

which program is used as part of medical program for the treatment of obesity, and as part of their surgical program for pre-surgery weight loss?

Answer 33

Optifast

Question 34

what is the risk of very low calorie diet? (Optifast)

Answer 34

risk of gallstones 3X greater than a low-calorie approach

Question 35

Overeaters Anonymous?

Answer 35

non-profit, self-help program led by peers; free program for compulsive eating recovery; scientific evidence minimal to recommend

Question 36

what is Slimfast?

Answer 36

self-directed program based on low-calorie meal replacement with online nutrition support and coaching text messages

Question 37

slimfast vs control/education?

Answer 37

results were mixed; One study did not show any difference regarding weight loss between Slimfast® and control/education, but most of the studies showed a difference in weight loss between groups, ranging from -5.2% to -8.7% from six months to 51 months. Compared to behavioural intervention, Slimfast® showed a modest weight loss difference, ranging from zero to -3.4% at three to 12 months. The attrition rate was not reported for most of the studies but, when reported it varied between 13% and 42%. Harms were not reported.1 At 12 months, there was no significant change in A1C between Slimfast® participants and the counselling group, but there was a greater reduction of oral hypoglycemic medication (40% reduction for sulfonylurea and 29% reduction of metformin).2 The comparison of WW® and Atkins® to Slimfast® did not demonstrate any difference on weight loss between the programs, but Slimfast® participants had an average of 4.5 mm Hg lower systolic blood pressure after six months compared to the Atkins® group.42 At six months, one randomized control trial found no significant difference in systolic and diastolic blood pressure between Slimfast® and control/education. Most trials did not report the variance estimates for between groups difference, which limits our ability to report statistical significance for blood pressure and lipids.5,49

Question 38

slimming world?

Answer 38

weekly community group meetings; Members are encouraged to do 30 minutes of physical activity and to eat low-energy-density food, plus extra calcium and fibre, with controlled amounts of high-energy-density foods; One randomized control trial showed that weight loss achieved with Slimming World was not statistically different than exercise alone after three and 12 months

Question 39

Take Off Pounds Sensibly (TOPS Club, Inc.)®?

Answer 39

a self-help, non-profit, weight loss program that recommends a low-calorie diet, featuring a curriculum on diet, physical activity and behaviour modification with weekly group sessions led by peers