Natural weight loss

Currently, there are many weight loss treatments proven to be at least somewhat effective. These include (but are not limited to):

• Behavioral programs
• Very-low-calorie diets (VLCD)
• Weight loss medications

The average weight loss for behavioral programs is reported to be approximately 1.5 pounds per week (0.5 kg). The average weight loss in individuals participating in a 12-week VLCD is about 33–44 pounds (15–20 kg), or approximately 2–4 pounds per week. As an example of a pharmacological treatment for obesity, a one-year study found that 40 percent of patients receiving medication lost at least 10 percent of their initial body weight, a goal achieved by only 21 percent of patients in the placebo group.

As noted earlier, weight loss can also be achieved through commercial weight loss programs or through individual counseling with a dietitian, a physician, or other health professional. The person who wants to lose weight has many options, but no one treatment works for every one.

Matching Individuals to Treatments

Given the fact that obesity is a multifaceted problem, and not all treatments work equally well for every person, some researchers have argued that individuals should be “matched” to a treatment that best suits their individual needs. Drs. Brownell and Wadden (Behavior Therapy 1991; 22:153–157) have offered a three-stage approach to matching individuals to weight loss treatment (see figure below). The first stage involves categorizing the person’s degree of excess weight.

A stepped-care approach comprises the second stage, which involves starting with the least restrictive measures—in terms of cost and treatment intensity. If the person does not respond to the first intervention within a reasonable length of time, he or she would then try the next step. For example, if a physician encourages an overweight patient to lose weight by suggesting regular exercise and a low-fat, low-calorie diet, and the individual does not lose weight in a reasonable time (e.g., after two months), the physician can refer the patient to a more structured weight loss program.

The influence of multiple factors is considered during the third stage, including individual needs and program characteristics. The person’s weight, dieting history, body composition, current eating patterns, and psychological functioning can affect the outcome in a weight management program. In addition, program factors such as cost, frequency of sessions, nutritional counseling, exercise instruction, use of dietary supplements, and program length may influence the matching decision.

Given the variety of overweight people and the fact that research findings suggest no single weight loss treatment is effective for every person, “matching” individuals to treatment appears to be a worthwhile venture. However, we need further research to learn if matching treatments increases the effectiveness of well-established weight loss programs. A recent, very costly trial of “matching” alcoholism treatments to patient characteristics found no improvement in outcomes (Project MATCH. Journal of Studies of Alcohol 1997; 58:7–29). Drs. Schwartz and Brownell (Journal of Consulting and Clinical Psychology 1995; 63:149–153) found that obesity experts consistently consider a handful of factors when matching treatments to individuals. These include the following three factors:

• Presence of a minimal degree of obesity for a clinician to recommend VLCDs or surgery
• An exercise component of the program
• Individual psychological counseling for individuals with psychiatric problems