Comparative effectiveness of weight loss treatments

Although several systematic literature reviews have examined the clinical and cost effectiveness of weight loss treatment options, the methods to evaluate efficacy have varied so widely that comparative effectiveness research has been hindered. We present results of a meta-analysis of randomized, clinical trials comparing the efficacy of various weight loss treatments to evaluate mean percent weight loss at one year attained by individual and commercial diets, FDA-approved pharmacological agents, and the two most commonly used bariatric surgical procedures in the U.S. (laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding). Among 21 trials of more than 6,700 participants, the average percent weight loss from baseline to one year reported for participants of individual diet groups was 1.4% (mean weight at baseline 93.1 kg, absolute weight loss 1.3 kg); commercial diet groups 4.7% (mean weight at baseline 92.1 kg, absolute weight loss 4.3 kg); sibutramine 6.5% (mean weight at baseline 97-104.3 kg, absolute weight loss 6.3 kg); orlistat 6.8% (mean weight at baseline 89.7-102.1 kg, absolute weight loss 6.7 kg); laparoscopic adjustable gastric banding 18.7% (mean weight at baseline 117.1-105.1 kg, absolute weight loss 42.4 kg); and laparoscopic Roux-en-Y gastric bypass (mean weight at baseline 118.2-162 kg, absolute weight loss 64.7 kg). Results of this meta-analysis may be useful in exploring future development of healthcare coverage and reimbursement for current and emerging weight loss treatments within the U.S. Continued efforts in this regard will need to balance treatment effectiveness, cost reductions in risk of weight-related comorbidities, and limitations of treatment.