Do Do-It-Yourself Interventions For Obesity Work?Tuesday, February 3, 2015
Given that most people do not look at obesity as a chronic disease that requires professional management, the most common approach to losing weight is still for people to try to lose weight on their own.
But just how effective are these do-it-yourself approaches to weight management?
This is the topic of a systematic review and meta-analysis by Jamie Hartmann-Boyce and colleagues from Oxford University, published in the American Journal of Public Health.
Self-help programs were defined as self-directed interventions that do not require professional input to deliver (“self-help”) across a variety of formats, including but not limited to print, Internet, and mobile phone-delivered programs.
As such programs come in all shapes and sizes, the researchers also distinguished between “tailored” interventions as those in which participant characteristics were used to provide individualized content (e.g., tailored based on information provided by participants at baseline), and “interactive” interventions as those programs in which participants could actively engage with intervention content (e.g., through online quizzes or entering their own content).
For each intervention, the authors also coded the specific type of self-managment strategies ranging from goal setting to buddy systems.
The researchers found 23 randomized controlled trials comparing self-help interventions with each other or with minimal controls in overweight and obese adults, with 6 months or longer follow-up. Together these studies included almost 10,000 participants in 39 intervention arms.
Although the researchers noted considerable heterogeneity among studies, the average difference in weight loss at 6 months between the self-management and control groups was about 2 Kg, an effect that was no longer significant at 12 months.
Overall the type of program (tailored vs. non-tailored, interactive vs. non-interactive, etc.) did not make any notable difference to the success of participants.
The authors also noted that the only trial that examined a potential interaction with socioeconomic status found that the intervention was more effective for more advantaged populations.
Despite these rather sobering results, the authors come to the rather astonishing conclusion that,
“Results from this review show promising evidence of the effectiveness of self-help interventions for weight loss.”
“Public health practitioners and policymakers should look to implement self-help interventions as a component of obesity intervention strategies because of the high reach and potentially low cost of these programs.”
How exactly, the authors would come to these recommendations is unclear – my view would be that this could be a rather substantial waste of public health funding that could probably be put to much better use.
Based on this paper (despite the enthusiastic conclusions of the authors), my conclusion would be that the vast majority of current self-management programs are probably not worth the time or effort.
This is not to say that self-management does not have an important role in obesity management – it certainly does, but evidently needs to occur under professional guidance.
So, if you do have a medically relevant weight problem – get professional help!
Hartmann-Boyce J, Jebb SA, Fletcher BR, & Aveyard P (2015). Self-Help for Weight Loss in Overweight and Obese Adults: Systematic Review and Meta-Analysis. American journal of public health PMID: 25602873
Tuesday, February 3, 2015
And then we find a program that actually works for us and it is belittled by some of the professionals. We stop listening to the professionals and stick with what seems to work for now, and lose faith in the professionals.
Wednesday, February 4, 2015
Those conclusions are flabbergasting. Western culture seems to suffer from a special form of blindness with regard to obesity. Not only are people in white coats susceptible to it; they perpetuate it. Then our lazy journalists just keep repeating it.
Maybe there’s a cause-and-effect happening too. A team of white coats know intuitively that if they want media attention, then they have to reach the conclusion that the press will print, which is Eat Less Move More, with or without a special program, (and government should fund it). On this blog, Dr. S, you have reported on all kinds of endocrine research and other things that do not reach the standard ELMM conclusions, but those don’t make it into the popular media. Grrr.
I ran across a booklet from the 1970s that espouses all the self-help tips and tricks that are currently perpetuated. Buddy system for exercise. Purging the kitchen of certain foods. Hiding those food that cannot be purged. Having your own personal “come to Jesus” moment where you realize why you are fat. Blah blah blah blah. Then you’re supposed to just eat less move more and you will be magically trim for the rest of you life. That was the 1970s! How’s that workin’ for us?! (Sorry, Dr. Phil.)
Now, disclaimer. I did it myself, and am maintaining myself. It involved, however, a number of “Oh Sh*T” realizations with regard to how the culture and people in white coats are wrong. For example, the idea that in maintenance you can “add back” certain foods as long as you don’t return to your former eating level. NO! You never add any quantity back that you weren’t eating in the last few weeks that you lost a pound. That’s your baseline, forever, and it only goes down. You pull back on your carbs. You gradually eat less and less and less. You try to maintain a level of exercise at age 55 that you established at 43. And your body rebels, but you fight to do it anyway. And if you are anything less than “inspirational” about it, well you’re just a negative Nelly who doesn’t know what you’re talking about, because, hey, the media are all reporting that it’s just a matter of eating less and moving more and adopting a zippy lifestyle. Why, here’s another study that confirms it! But, as this study reveals, it really doesn’t. It just reveals cultural blindness in people who wear white coats.
So, you shut up. You start a blog for a while. You move on. You read Dr. Sharma’s blog. You find the joy in other areas of your life and you don’t talk about weight at all. When friends get all gushy about an article in O magazine, you may discourage them from believing everything they read. But you do it vaguely. No one likes a negative Nelly.
Wednesday, February 11, 2015
Thank you Fred and Debra. I have walked that lonely road too, starting with being sugar free, then sugar and grain free. Minimize carbs and make sure they are pretty much all vegetables. Get your daily protein requirement Eat more fat. It is really the only formula that has worked for me. And you’re right, the struggle is for life. No “adding back” – ever.
There is so much internet noise about how to lose weight. Little inspiration for maintenance. Dr. Sharma is one of the few who recognize that. Another good website is Dr. Barbara Berkeley’s “Refuse to Regain”. The URL is: http://www.refusetoregain.com/