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Behavioral Weight Loss Programs are Effective, but Where to Find Them?

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US Preventive Services Task Force Recommends Intensive Behavioral Programs for Weight Loss

The US Preventive Services Task Force (USPSTF) is a team of volunteer experts from various primary care medicine and nursing fields. Their goal is to identify big medical problems, review the research, and translate it into action plans (called practice recommendations) for doctors. In their recent fall recommendations, the task force focused on tackling obesity, which is associated with diseases such as diabetes, high blood pressure, and heart disease.

The task force analyzed 89 behavioral weight loss program trials involving either behavioral or medication-based weight loss programs. The programs studied lasted between 12 and 24 months, and involved at least 12 sessions. These programs were intensive and focused on lasting diet and lifestyle changes, involving specialists such as behavioral therapists, psychologists, registered dietitians, exercise physiologists, lifestyle coaches, and physicians.

Participants in these programs had significant weight loss compared to controls, averaging between 1 and 20 pounds, with an average weight loss of 5 pounds overall, and were more likely to have lost 5% of their total body weight at 12 to 18 months. Thirteen trials looked at diabetes risk, and pooled results showed that participants had a significantly lower risk of developing diabetes. The risks of participating in these studies were minimal, making it a major plus to behavioral weight loss interventions, which have no side effects or drug complications.

Comparing behavioral programs with medications, the USPSTF found that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels. The medication studies demonstrated significant weight loss, ranging from 2 to 13 pounds. However, the many medical contraindications of some of these medications, and the side effects, some quite serious, resulted in high dropout rates.

Indeed, the USPSTF recommends intensive, multicomponent behavioral interventions in adults with obesity for weight loss. These programs work well for weight loss and are extremely low-risk to boot, making them an effective strategy for disease prevention.

The Challenge of Accessing Behavioral Weight Loss Programs

Accessing behavioral weight loss programs can be challenging for individuals seeking professional support for their weight loss journey. Despite the effectiveness of some of these programs, not everyone qualifies for insurance coverage, and out-of-pocket costs can be expensive. This article explores the different options available to individuals seeking to join these programs.

Behavioral Weight Loss Programs: Where to Sign Up

The Diabetes Prevention Program (DPP) is a well-studied, intensive lifestyle change behavioral weight loss program that has been in existence for decades. However, insurance coverage is only available to individuals with a confirmed diagnosis of prediabetes and a BMI over 25. The program, which includes 22 learning sessions, is available both online and in-person and is free on the Centers for Disease Control (CDC) website.

To find a recognized DPP program, individuals can check out the CDC's registry, although the process of obtaining official recognition can take time. While some hospitals offer behavioral lifestyle change programs, they are often expensive and not covered by insurance.

Alternative Approaches to Behavioral Weight Loss Programs

For individuals who cannot access behavioral weight loss programs, other approaches can be effective. These include consulting with relevant specialists, following personal progress, and arranging peer support. Mobile phone apps can also be effective in aiding weight loss journeys. Several free, widely available apps include MyFitnessPal, Lose It, Noom, Weight Watchers, and Fooducate.

While accessing behavioral weight loss programs can be a challenge, individuals can seek out alternative approaches to achieve their weight loss goals. The hope is that in the future, more guidelines-based intensive lifestyle change programs will be widely accessible to those in need of support.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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