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Weighing the Options: Criteria for Evaluating Weight-Management Programs
TYPES OF WEIGHT-LOSS PROGRAMS
Do-it-yourself programs are individually formulated and therefore extraordinarily varied. This category includes any effort by an individual to lose weight by himself or herself or with a group of like-minded others, through programs such as Overeaters Anonymous and TOPS (Take Off Pounds Sensibly) or community-based and work-site programs. Individual judgment, books, products, and group therapy may dispense good or bad advice. The common denominator of programs in this category is that outside resources are not used in a personalized or individualized manner. We have identified five general subcategories of self-help programs:
One subcategory includes the individual who is losing weight with a personally formulated low-calorie program with or without exercise, regardless of the safety or other characteristics of this effort. A second subcategory involves those who derive guidance from popular published materials such as books or magazines with diet instructions. A third subcategory includes those who use any of a number of popularly promoted products such as diet aids, low-calorie foods, and meal replacements. A fourth subcategory includes those who participate in a group as a source of counseling, advice, structure, or reinforcement. The fifth subcategory includes those participating in community-based and work-site programs.
Nonclinical programs are popular and are often commercially franchised. They typically have a structure created by a parent company and often use instructional and guidance materials that are prepared in consultation with health-care providers. The qualifying characteristic of these programs is that they rely substantially on variably trained counselors (who are not health-care providers by our definition) to provide services to the individual client. However, these programs are often managed or advised by qualified and licensed health-care providers. They may or may not sell prepared food products, meal replacements, or other products to their clients. Many popular weight-loss centers offer advice on nutrition, physical activity, and behavior modification, which is provided at weekly classes or meetings. Specific outcomes of any of these programs are unknown, since little or no published data are available (Stunkard, 1992).