 Primary care doctors play a critical role in the medical system. They form relationships with patients, manage all kinds of chronic and acute conditions, and determine when specialist care is needed. In recent years, however, these front line doctors are finding themselves faced with a conundrum. A growing proportion of their patients are overweight or obese, but most doctors lack specific training on the treatment of obesity, and many simply don’t have the time to discuss appropriate treatment options with these patients. Doctors that are situated within large academic centers may have the luxury of referring patients to registered dietitians, or even to medical or surgical weight management programs. But for doctors in the community, knowing where to send these patients can be a major problem.  Commercial programs such as Weight Watchers may offer a welcome outlet for busy primary care doctors. These businesses are ubiquitous across much of the U.S., with fabulous advertising campaigns that make them familiar to most patients. The question is – what is the evidence that they actually work?
A recent systematic review by Dr. Kimberly Gudzune and colleagues, published in the Annals of Internal Medicine, provides an excellent overview of recent evidence to help answer this question. The authors examined published data on the efficacy of 11 commercial programs, but much of the resulting discussion focused on the 3 programs with the largest U.S. market share – Weight Watchers, Nutrisystem and Jenny Craig (which are also the 3 programs with the most published RCT data). The authors conclude that, relative to control participants, those in Weight Watchers and Jenny Craig displayed statistically significant weight loss that was sustained at 12 months. Compared to the men and women shown in commercials standing inside one of their old pant legs, the randomized trial participants only slightly edged out their control counterparts – achieving about 2.6% additional weight loss for Weight Watchers, and 4.9% for Jenny Craig. As Gudzune and her co-authors note, Weight Watchers achieves this change at a much lower price tag than Jenny Craig (although the former does not include the cost of food). They are also careful to mention that the risk of publication bias with most of the studies they reviewed was quite high. So, should primary care doctors take this as a green light to refer their patients to commercial programs? Maybe. As Dr. Gudzune and her colleagues point out, the control groups in many of the RCTs they reviewed did not receive intense primary care-based interventions. Perhaps there wouldn’t actually be much of a benefit to commercial programs if they were compared to structured counseling programs delivered through primary care? On the other hand, in the absence of such a program, or in cases where PCPs simply don’t think they have the time or expertise to provide this kind of advice, referral to commercial programs could be a good option. Doctors choosing this pathway will need to calibrate patient expectations of weight loss and out-of-pocket costs, though, in addition to planning for follow-up within their own clinics.
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