Losing weight, and keeping it off, is one of the most difficult health recommendations for many people to follow — but also potentially one of the most beneficial. Studies have shown that in people with diabetes who are overweight or obese, losing just 5% to 10% of your body weight can have major benefits in areas like blood glucose control and blood triglyceride levels.
There’s no single, proven best way to lose weight, which means that many people who set out to lose weight are navigating a variety of different — and sometimes conflicting — recommendations. And even when people have a clear strategy to follow to lose weight, it can be difficult to stick with that strategy due to many different factors — from limited time to prepare healthy foods or exercise, to the difficulty of maintaining motivation to follow through with your plans.
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Many healthcare providers try to address some of the difficulties inherent to losing weight through structured weight-loss programs. These programs take many different designs, from exercise-intensive programs that involve appointments with fitness coaches, to diet-centered programs that involve meeting periodically with a dietitian. But one thing that many programs have in common is that they involve one-on-one meetings or appointments with healthcare professionals.
A new study suggests there may be a more effective way to organize weight-loss programs: by having them meet in groups.
Group program works best in rural setting
The study, published in the journal JAMA, looked at two different types of structured weight-loss programs offered at 36 different primary care clinics across the rural Midwest. Participants — a total of 1,407 obese people ages 20 to 75 — were randomly assigned to take part either an individual or a group in-person program, or a telephone-based group program. Each program was designed to be a “lifestyle intervention” focused on diet, physical activity and behavior change strategies.
The individual in-person program involved weekly 15-minute visits for one month, followed by biweekly visits for five months and then monthly visits. For the the group program, participants met weekly for three months, biweekly for three months, and then monthly. The telephone group program worked the same as the in-person group program, only with conference calls instead of physical meetings. Participants started participating between February 2016 and October 2017, and the study ended in December 2019.
Researchers were most interested in comparing participants’ weight changes after 24 months of participation in their assigned program. In doing so, they defined a “clinically significant” difference as a change of at least 2.75 kilograms (6.06 pounds).
After taking part in the program for 24 months, the average weight loss for people in the in-person group program was 4.4 kilograms (9.7 pounds). For the telephone group program it was 3.9 kilograms (8.6 pounds), and for the in-person individual program it was 2.6 kilograms (5.7 pounds). This means that according to the researchers’ definition, only members of the individual program didn’t experience clinically significant weight loss, on average.
But when the researchers looked at a different way of measuring a program’s success — the proportion of people who lost at least 5% of their body weight — there were no significant differences between the three programs. “Therefore, although the 24-month mean difference between in-clinic group and in-clinic individual visits was statistically significant, the absolute difference in weight loss of -1.9 kg was small in magnitude and may not represent a clinically important difference,” the researchers wrote.
Why might group programs be better?
The researchers noted that although the differences between groups in the study were fairly small, their findings still support the efficacy of group-based weight-loss programs — especially ones that meet in person. This was, of course, before the COVID-19 pandemic, but the study’s findings also suggest that a telephone-based group program is a good alternative to meeting in person.
In particular, the researchers wrote, group-based programs may be effective in rural areas where there isn’t much access to evidence-based weight-loss programs, and where many people are obese. It’s possible that people in this setting were more motivated to lose weight when they took part in a group program, since they might not have other good sources of motivation or inspiration in their daily lives. Of course, this situation might apply to people outside rural areas, as well.
Potential limitations of this study include its overwhelmingly white (96%) and Midwestern group of participants, and the fact that most of them were women (77%). It’s unknown whether the study’s findings would apply to other areas of the country, such as predominantly Black rural areas in the South, or whether more men could be convinced to participate in these programs — and if more men did participate, whether group programs would still be just as effective in men as in women.