Weight loss with self-help compared with a structured commercial program: a randomized trial

JAMA. 2003 Apr 9;289(14):1792-8. doi: 10.1001/jama.289.14.1792.


Context: Although commercial weight loss programs provide treatment to millions of clients, their efficacy has not been evaluated in rigorous long-term trials.

Objective: To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program.

Design and setting: A 2-year, multicenter randomized clinical trial with clinic visits at 12, 26, 52, 78, and 104 weeks conducted at 6 academic research centers in the United States between January 1998 and January 2001.

Participants: Overweight and obese men (n = 65) and women (n = 358) (body mass index, 27-40) aged 18 to 65 years.

Intervention: Random assignment to either a self-help program (n = 212) consisting of two 20-minute counseling sessions with a nutritionist and provision of self-help resources or to a commercial weight loss program (n = 211) consisting of a food plan, an activity plan, and a cognitive restructuring behavior modification plan, delivered at weekly meetings.

Main outcome measures: Weight change was the primary outcome measure. Secondary outcomes included waist circumference, body mass index, blood pressure, serum lipids, glucose, and insulin levels.

Results: At 2 years, 150 participants (71%) in the commercial group and 159 (75%) in the self-help group completed the study. In the intent-to-treat analysis, mean (SD) weight loss of participants in the commercial group was greater than in the self-help group at 1 year (-4.3 [6.1] kg vs -1.3 [6.1] kg, respectively; P<.001) and at 2 years (-2.9 [6.5] kg vs -0.2 [6.5] kg, respectively; P<.001). Waist circumference (P =.003) and body mass index (P<.001) decreased more in the commercial group. Changes in blood pressure, lipids, glucose, and insulin levels were related to changes in weight in both groups, but between-group differences in biological parameters were mainly nonsignificant by year 2.

Conclusion: The structured commercial weight loss program provided modest weight loss but more than self-help over a 2-year period.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anthropometry
  • Body Mass Index
  • Counseling
  • Exercise
  • Female
  • Health Promotion*
  • Humans
  • Male
  • Middle Aged
  • Nutritional Sciences / education
  • Obesity / blood
  • Obesity / therapy*
  • Outcome Assessment, Health Care
  • Patient Education as Topic
  • Patient Participation
  • Quality of Life
  • Risk Reduction Behavior
  • Self Care*
  • Weight Loss* / physiology